Surgical treatment of insulinomas

被引:73
作者
Finlayson, E
Clark, OH
机构
[1] Univ Calif San Francisco, Dept Surg, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Ctr Comprehens Canc, Dept Surg, San Francisco, CA 94143 USA
关键词
D O I
10.1016/j.suc.2004.02.004
中图分类号
R61 [外科手术学];
学科分类号
摘要
Differential diagnosis of hypoglycemic patients should include insulinoma. Plasma insulin-to-glucose ratio greater than 0.3 or C-peptide levels of 2 nmol/L or greater suggest insulinoma. Abdominal CT scan can exclude metastatic disease and identify uncommonly large islet cell tumors, but has poor sensitivity for localizing insulinomas; transgastric endoscopic ultrasound is the most sensitive technique. Palpation combined with intraoperative ultrasound identifies most tumors at operation and gives vital information about surrounding structures. If no tumor is found, blind distal pancreatectomy should not be performed, and the patient should be referred to an endocrinologist or endocrine surgeon for diagnostic confirmation and further localization. Laparoscopy is a viable alternative to open tumor resection; laparoscopic ultrasound can facilitate localization and guide safe resection.
引用
收藏
页码:775 / +
页数:12
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