目的 总结腹腔镜胰岛细胞瘤切除的手术技巧和临床经验.方法 2002年7月至2007年12月共收治胰岛细胞瘤患者30例,男性12例,女性18例,其中术前诊断为无功能胰岛细胞瘤3例,胰岛素瘤27例.所有患者术前影像学检查至少1项为阳性,肿瘤位于胰头颈部4例,体尾部26例.结果 其中2例腹腔镜超声探查未发现病灶而终止手术,其余28例发现病灶并成功在腹腔镜下切除(联合胆囊切除5例).手术方式包括局部切除13例(钩突1例、胰头颈部3例、体尾部9例),胰体尾脾切除15例(其中保脾7例).手术时间165 rain(65～465 min),出血145 nd(50～800ml).术后3例发生胰漏,其中2例经过保守治疗愈合,1例行经十二指肠胰胆管逆行造影胰管支架置入后治愈.术后住院天数为5.6 d(2～17 d).无中转开腹及手术死亡.随访4～62个月,平均(14.3±16.7)个月,无肿瘤复发.2例仍有发作性低血糖,1例血糖高(发病前有糖尿病),需要口服降糖药,其余27例血糖正常.结论 完全腹腔镜下胰岛细胞瘤切除是一种安全可行的方法 ,术中超声有助于肿瘤的准确定位和手术的顺利进行.%Objective To summarize the surgical technique and clinical experience of total laparoscopic resection of the pancreatic islet cell tumors.Methods From July 2002 to December 2007,30 cases including 12 males and 18 females were diagnosed as pancreatic islet cell tumor.There were at least one positive imaging examination of each patient preoperatively.The location of the tumors included 4 in proximal pancreas and 26 in distal pancreas.Results The tumors were successfully found and removed in 28 cases and unsuccessfully located in the other 2 cases.The procedures included local resections in 13 cases and distal pancreatectomies in 15 cases(spleen reserved in 7 cases).The mean operation time Was 165 min (range,65-465 min).The mean blood loss was 145 ml(range,50-800 ml).Pancreatic leakage occurred in 3 cages,2 of which were cured conservatively.And the other one were cured by endoscopic retrograde cannulation of the pancreatic duct.The mean postoperative hospital stay was 5.6 days(range,2-17 d).There were no conversions and death.After follow up of(14.3±16.7)months(range,4-62 months),there were no recurrences.Conclusion Total laparoscopic resection is a safe and effective method for pancreatic islet cell tumors.
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