Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:...Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was conducted.The demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic groups.Results:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic approach.Enucleation was the preferred surgical procedure.Fifty-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,respectively.Robotic enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic enucleation.There were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and complications.After a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a recurrence.Conclusions:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.展开更多
Objective To investigate the efficacy of raw corn starch(RCS)in clinical management of insulinoma-induced hypoglycemia.Methods We retrospectively collected clinical data of insulinoma patients who received RCS-supplem...Objective To investigate the efficacy of raw corn starch(RCS)in clinical management of insulinoma-induced hypoglycemia.Methods We retrospectively collected clinical data of insulinoma patients who received RCS-supplemented diet preoperatively,and analyzed the therapeutic effects of the RCS intervention on blood glucose control,weight change,and its adverse events.Results The study population consisted of 24 cases of insulinoma patients,7 males and 17 females,aged 46.08±14.15 years.Before RCS-supplemented diet,all patients had frequent hypoglycemic episodes(2.51±3.88 times/week),concurrent with neuroglycopenia(in 83.3% of patients)and autonomic manifestations(in 75.0% of patients),with the median fasting blood glucose(FBG)of 2.70(interquartile range[IQR]:2.50-2.90)mmol/L.The patients'weight increased by 0.38(IQR:0.05-0.65)kg per month,with 8(33.3%)cases developing overweight and 7(29.2%)cases developing obesity.All patients maintained the RCS-supplemented diet until they underwent tumor resection(23 cases)and transarterial chemoembolization for liver metastases(1 case).For 19 patients receiving RCS throughout the day,the median FBG within one week of nutritional management was 4.30(IQR:3.30-5.70)mmol/L,which was a significant increase compared to pre-nutritional level[2.25(IQR:1.60-2.90)mmol/L;P<0.001].Of them,10 patients receiving RCS throughout the day for over four weeks had sustained improvement in FBG compared to pre-treatment[3.20(IQR:2.60-3.95)mmol/L vs.2.15(IQR:1.83-2.33)mmol/L;P<0.001].Five patients who received RCS only at night also had a significant increase in FBG within one week of nutritional management[3.50(IQR:2.50-3.65)mmol/L vs.2.20(IQR:1.80-2.60)mmol/L;P<0.001],but only one patient who continued to receive RCS for over four weeks did not have a significant improvement in FBG.No improvement in weight gain was observed upon RCS supplementation.Mild diarrhea(2 cases)and flatulence(1 case)occurred,and were relieved by reduction of RCS dose.Conclusion The RCS-supplemented diet is effective in controlling insulinoma-induced hypoglycemia.展开更多
Insulinomas,the most common cause of hypoglycemia related to endogenous hyperinsulinism,occur in 1-4 people per million of the general population.Common autonomic symptoms of insulinoma include diaphroresis,tremor,and...Insulinomas,the most common cause of hypoglycemia related to endogenous hyperinsulinism,occur in 1-4 people per million of the general population.Common autonomic symptoms of insulinoma include diaphroresis,tremor,and palpitations,whereas neuroglycopenenic symptoms include confusion,behavioural changes,personality changes,visual disturbances,seizure,and coma.Diagnosis of suspected cases is based on standard endocrine tests,especially the prolonged fasting test.Non-invasive imaging procedures,such as computed tomography and magnetic resonance imaging,are used when a diagnosis of insulinoma has been made to localize the source of pathological insulin secretion.Invasive modalities,such as endoscopic ultrasonography and arterial stimulation venous sampling,are highly accurate in the preoperative localization of insulinomas and have frequently been shown to be superior to noninvasive localization techniques.The range of techniques available for the localization of insulinomas means thatblind resection can be avoided.Intraoperative manual palpation of the pancreas by an experienced surgeon and intraoperative ultrasonography are both sensitive methods with which to finalize the location of insulinomas.A high proportion of patients with insulinomas can be cured with surgery.In patients with malignant insulinomas,an aggressive medical approach,including extended pancreatic resection,liver resection,liver transplantation,chemoembolization,or radiofrequency ablation,is recommended to improve both survival and quality of life.In patients with unresectable or uncontrollable insulinomas,such as malignant insulinoma of the pancreas,several techniques should be considered,including administration of ocreotide and/or continuous glucose monitoring,to prevent hypoglycemic episodes and to improve quality of life.展开更多
Objective: To summarize retrospectively the experi- ence in diagnosis and surgical treatment of pancreatic insulinoma. Method: 74 patients who had been operated on and confirmed pathologically from July 1967 to July 2...Objective: To summarize retrospectively the experi- ence in diagnosis and surgical treatment of pancreatic insulinoma. Method: 74 patients who had been operated on and confirmed pathologically from July 1967 to July 2001 were enrolled. They were 37 men and 37 women, aged 41.91 years on average. Results: In all patients with typical Whipple's triad, the ratio of insulin to glucose was measured over 0.3 for at least one time. 52.70 % of the patients were once misdiagnosed, and only 20.27 % of them were correctly diagnosed in a year after onset of symp- toms. Their average course of the disease was 3.36 years. B-ultrasonography and endoscopic ultrasonog- raphy (EUS) showed a low positive rate for localiza- tion of insulinoma. CT and magnetic resonance ima- ging (MRI) could correctly detected 63.41% and 63.64 % of tumors respectively, in sharp contrast to a localization rate of 90 % for arterial stimulation and venous sampling (ASVS). Single insulinoma was ob- served in 66 patients (89.19 %), multiple insulinoma in 2 (2.70 %), hyperplasia in 4 (5.41%), and malig- nant insulinoma in 2 (2. 70%). Most (85. 29%) of the benign insnlinomas were less than 2 cm in diame- ter. Simple enucleation was the major operative pro- cedure for benign tumors. In 88. 52% of the pa- tients, glycemia increased to normal in 30 minutes after tumor excision, and in the remaining patients within 2 hours. 97. 26% of the patients experienced temporary hyperglycemia but recovered in a week. The major complications of insnlinoma included pan- creatic fistulae (27.27 %) and pancreatitis (5. 19 %). Conclusions: Better recognization of insulinoma and its rational examination are essential to early diagno- sis. CT can be first used for localization, otherwise ASVS is used. Surgery is the major choice for the treatment of insulinoma, but cautions should be taken to pancreatic fistulae after operation.展开更多
Objective: To study the methods for diagnosis andtreatment of insulinoma.Methods: Clinical data from 105 patients with insuli-noma who had been admitted to our hospital from Ju-ly 1966 to December 1999 were retrospect...Objective: To study the methods for diagnosis andtreatment of insulinoma.Methods: Clinical data from 105 patients with insuli-noma who had been admitted to our hospital from Ju-ly 1966 to December 1999 were retrospectively re-viewed.Results: Fasting blood glucose values were less than2.75 mmol/L in all the patients. Fasting serum insulinvalues in 60 patients were higher than 25 mU/L, av-erage 65 mU/L. Before operation, carcinoma was de-tected in 2 of 45 patients by ultrasound scan, and in10 of 35 by CT. Enucleation of insulinoma was per-formed in 60 patients. Operations included insulinomaresection (35 patients), distal resection of the pancreas(8), and biopsy (2).Conclusion: Whipple's triad and the index of insulinrelease>0.3 are the major variables for diagno-sis Intraoperative exploration and ultrasound scan are themethods for the localization of insulinoma Enucleation ofbenign insulinoma is preferred, but proximal or distal re-sections of the pancreas are required only for large, deep ormultiple tumors展开更多
Insulinoma is a rare disease presenting with episodic neuroglycopenic and/or adrenergic symptoms. We describe the clinical case of a female subject, 44 years old, affected with insulinoma, misdiagnosed for two years a...Insulinoma is a rare disease presenting with episodic neuroglycopenic and/or adrenergic symptoms. We describe the clinical case of a female subject, 44 years old, affected with insulinoma, misdiagnosed for two years as epilepsy, threaten with antiepileptics. Insuli-noma was diagnosed based on fasting blood glucose level of 15 mg/dl, high fasting immunoreactive insu-lin/blood glucose ratio (more than 0.3), and a tumor in the pancreas by abdominal CT. After surgical re-moval of the neoplasm, the blood glucose level and insulin level turned normal. A benign insulinoma was also confirmed by histopathological evaluation. The patient remained seizure-free during the 2-year follow up.展开更多
Objective To evaluate the value of intra-arterial dynamic spiral CT on preoperative localization of insulinoma. Methods Two patients with insulinoma proved by operative pathology were preoperatively localized by int...Objective To evaluate the value of intra-arterial dynamic spiral CT on preoperative localization of insulinoma. Methods Two patients with insulinoma proved by operative pathology were preoperatively localized by intra-arterial dynamic spiral CT. Results In intra-arterial spiral CT, two small insulinomas (1.5–2.0 cm in diameter) demonstrated as a significantly high dense nodule 20 s later after initiation of injection of contrast medium. The course of high density lasted nearly 4 min. Conclusion Intra-arterial dynamic spiral CT could clearly detect small insulinoma, and might be one of most effective preoperative localization methods for small insulinoma. Key words insulinoma - anteriography - CT展开更多
文摘Background:Minimally invasive surgery is the optimal treatment for insulinoma.The present study aimed to compare short-and long-term outcomes of laparoscopic and robotic surgery for sporadic benign insulinoma.Methods:A retrospective analysis of patients who underwent laparoscopic or robotic surgery for insulinoma at our center between September 2007 and December 2019 was conducted.The demographic,perioperative and postoperative follow-up results were compared between the laparoscopic and robotic groups.Results:A total of 85 patients were enrolled,including 36 with laparoscopic approach and 49 with robotic approach.Enucleation was the preferred surgical procedure.Fifty-nine patients(69.4%)underwent enucleation;among them,26 and 33 patients underwent laparoscopic and robotic surgery,respectively.Robotic enucleation had a lower conversion rate to laparotomy(0 vs.19.2%,P=0.013),shorter operative time(102.0 vs.145.5 min,P=0.008)and shorter postoperative hospital stay(6.0 vs.8.5 d,P=0.002)than laparoscopic enucleation.There were no differences between the groups in terms of intraoperative blood loss,the rates of postoperative pancreatic fistula and complications.After a median follow-up of 65 months,two patients in the laparoscopic group developed a functional recurrence and none of the patients in the robotic group had a recurrence.Conclusions:Robotic enucleation can reduce the conversion rate to laparotomy and shorten operative time,which might lead to a reduction in postoperative hospital stay.
基金supported by the National High Level Hospital Clinical Research Fund(2022-PUMCH-A-146)the National Natural Science Foundation of China(72074222)the Na-tional Key Research and Development Program of China(2020YFC2005005).
文摘Objective To investigate the efficacy of raw corn starch(RCS)in clinical management of insulinoma-induced hypoglycemia.Methods We retrospectively collected clinical data of insulinoma patients who received RCS-supplemented diet preoperatively,and analyzed the therapeutic effects of the RCS intervention on blood glucose control,weight change,and its adverse events.Results The study population consisted of 24 cases of insulinoma patients,7 males and 17 females,aged 46.08±14.15 years.Before RCS-supplemented diet,all patients had frequent hypoglycemic episodes(2.51±3.88 times/week),concurrent with neuroglycopenia(in 83.3% of patients)and autonomic manifestations(in 75.0% of patients),with the median fasting blood glucose(FBG)of 2.70(interquartile range[IQR]:2.50-2.90)mmol/L.The patients'weight increased by 0.38(IQR:0.05-0.65)kg per month,with 8(33.3%)cases developing overweight and 7(29.2%)cases developing obesity.All patients maintained the RCS-supplemented diet until they underwent tumor resection(23 cases)and transarterial chemoembolization for liver metastases(1 case).For 19 patients receiving RCS throughout the day,the median FBG within one week of nutritional management was 4.30(IQR:3.30-5.70)mmol/L,which was a significant increase compared to pre-nutritional level[2.25(IQR:1.60-2.90)mmol/L;P<0.001].Of them,10 patients receiving RCS throughout the day for over four weeks had sustained improvement in FBG compared to pre-treatment[3.20(IQR:2.60-3.95)mmol/L vs.2.15(IQR:1.83-2.33)mmol/L;P<0.001].Five patients who received RCS only at night also had a significant increase in FBG within one week of nutritional management[3.50(IQR:2.50-3.65)mmol/L vs.2.20(IQR:1.80-2.60)mmol/L;P<0.001],but only one patient who continued to receive RCS for over four weeks did not have a significant improvement in FBG.No improvement in weight gain was observed upon RCS supplementation.Mild diarrhea(2 cases)and flatulence(1 case)occurred,and were relieved by reduction of RCS dose.Conclusion The RCS-supplemented diet is effective in controlling insulinoma-induced hypoglycemia.
基金Supported by Kochi Organization for Medical Reformation and Renewal Fundthe support of SatoshiIto and Kazuhiro Hanazaki(Kochi Medical School)
文摘Insulinomas,the most common cause of hypoglycemia related to endogenous hyperinsulinism,occur in 1-4 people per million of the general population.Common autonomic symptoms of insulinoma include diaphroresis,tremor,and palpitations,whereas neuroglycopenenic symptoms include confusion,behavioural changes,personality changes,visual disturbances,seizure,and coma.Diagnosis of suspected cases is based on standard endocrine tests,especially the prolonged fasting test.Non-invasive imaging procedures,such as computed tomography and magnetic resonance imaging,are used when a diagnosis of insulinoma has been made to localize the source of pathological insulin secretion.Invasive modalities,such as endoscopic ultrasonography and arterial stimulation venous sampling,are highly accurate in the preoperative localization of insulinomas and have frequently been shown to be superior to noninvasive localization techniques.The range of techniques available for the localization of insulinomas means thatblind resection can be avoided.Intraoperative manual palpation of the pancreas by an experienced surgeon and intraoperative ultrasonography are both sensitive methods with which to finalize the location of insulinomas.A high proportion of patients with insulinomas can be cured with surgery.In patients with malignant insulinomas,an aggressive medical approach,including extended pancreatic resection,liver resection,liver transplantation,chemoembolization,or radiofrequency ablation,is recommended to improve both survival and quality of life.In patients with unresectable or uncontrollable insulinomas,such as malignant insulinoma of the pancreas,several techniques should be considered,including administration of ocreotide and/or continuous glucose monitoring,to prevent hypoglycemic episodes and to improve quality of life.
文摘Objective: To summarize retrospectively the experi- ence in diagnosis and surgical treatment of pancreatic insulinoma. Method: 74 patients who had been operated on and confirmed pathologically from July 1967 to July 2001 were enrolled. They were 37 men and 37 women, aged 41.91 years on average. Results: In all patients with typical Whipple's triad, the ratio of insulin to glucose was measured over 0.3 for at least one time. 52.70 % of the patients were once misdiagnosed, and only 20.27 % of them were correctly diagnosed in a year after onset of symp- toms. Their average course of the disease was 3.36 years. B-ultrasonography and endoscopic ultrasonog- raphy (EUS) showed a low positive rate for localiza- tion of insulinoma. CT and magnetic resonance ima- ging (MRI) could correctly detected 63.41% and 63.64 % of tumors respectively, in sharp contrast to a localization rate of 90 % for arterial stimulation and venous sampling (ASVS). Single insulinoma was ob- served in 66 patients (89.19 %), multiple insulinoma in 2 (2.70 %), hyperplasia in 4 (5.41%), and malig- nant insulinoma in 2 (2. 70%). Most (85. 29%) of the benign insnlinomas were less than 2 cm in diame- ter. Simple enucleation was the major operative pro- cedure for benign tumors. In 88. 52% of the pa- tients, glycemia increased to normal in 30 minutes after tumor excision, and in the remaining patients within 2 hours. 97. 26% of the patients experienced temporary hyperglycemia but recovered in a week. The major complications of insnlinoma included pan- creatic fistulae (27.27 %) and pancreatitis (5. 19 %). Conclusions: Better recognization of insulinoma and its rational examination are essential to early diagno- sis. CT can be first used for localization, otherwise ASVS is used. Surgery is the major choice for the treatment of insulinoma, but cautions should be taken to pancreatic fistulae after operation.
文摘Objective: To study the methods for diagnosis andtreatment of insulinoma.Methods: Clinical data from 105 patients with insuli-noma who had been admitted to our hospital from Ju-ly 1966 to December 1999 were retrospectively re-viewed.Results: Fasting blood glucose values were less than2.75 mmol/L in all the patients. Fasting serum insulinvalues in 60 patients were higher than 25 mU/L, av-erage 65 mU/L. Before operation, carcinoma was de-tected in 2 of 45 patients by ultrasound scan, and in10 of 35 by CT. Enucleation of insulinoma was per-formed in 60 patients. Operations included insulinomaresection (35 patients), distal resection of the pancreas(8), and biopsy (2).Conclusion: Whipple's triad and the index of insulinrelease>0.3 are the major variables for diagno-sis Intraoperative exploration and ultrasound scan are themethods for the localization of insulinoma Enucleation ofbenign insulinoma is preferred, but proximal or distal re-sections of the pancreas are required only for large, deep ormultiple tumors
文摘Insulinoma is a rare disease presenting with episodic neuroglycopenic and/or adrenergic symptoms. We describe the clinical case of a female subject, 44 years old, affected with insulinoma, misdiagnosed for two years as epilepsy, threaten with antiepileptics. Insuli-noma was diagnosed based on fasting blood glucose level of 15 mg/dl, high fasting immunoreactive insu-lin/blood glucose ratio (more than 0.3), and a tumor in the pancreas by abdominal CT. After surgical re-moval of the neoplasm, the blood glucose level and insulin level turned normal. A benign insulinoma was also confirmed by histopathological evaluation. The patient remained seizure-free during the 2-year follow up.
文摘Objective To evaluate the value of intra-arterial dynamic spiral CT on preoperative localization of insulinoma. Methods Two patients with insulinoma proved by operative pathology were preoperatively localized by intra-arterial dynamic spiral CT. Results In intra-arterial spiral CT, two small insulinomas (1.5–2.0 cm in diameter) demonstrated as a significantly high dense nodule 20 s later after initiation of injection of contrast medium. The course of high density lasted nearly 4 min. Conclusion Intra-arterial dynamic spiral CT could clearly detect small insulinoma, and might be one of most effective preoperative localization methods for small insulinoma. Key words insulinoma - anteriography - CT
