BACKGROUND:The persistent hyperinsulinemic hypoglycemia is characterized by clinical symptoms that occur when the blood glucose levels drop below the normal range. Two pathological situations cause this clinical problem: The presence of a tumor of the pancreas secreting excessive amounts of insulin, known as insulinoma, and congenital beta-cell hyperplasia in the pancreas in children and noninsulinoma pancreatogenic hypoglycemia syndrome in adults. PATIENTS AND METHODS:Clinical characteristic and surgical outcome of a group of 20 patients operated on for this hypoglycemic syndrome; 18 for insulinoma and two for nesidioblastosis in children was studied. RESULTS:eight of the insulinomas were in the head of the pancreas, two in the body, and the remaining eight in the tail. The surgical technique was enucleation in nine cases, local resection in one case because of suspicious malignancy, and distal pancreatectomy in eight cases. Both children with nesidioblastosis underwent 85% pancreatectomy with splenic preservation. There was no mortality in the study, but three patients developed a low-volume pancreatic fistula after head enucleation. CONCLUSIONS:Negative results in diagnostic localization together with the small size of the insulinoma represent a poor combination for successful surgery. The intraoperative ultrasonography is the method of choice for the identification of the tumor, as it is able to identify nonpalpable lesions.

译文

背景:持续性高胰岛素血症性低血糖的特征是当血糖水平降至正常范围以下时出现的临床症状。有两种病理情况导致此临床问题:儿童胰腺中存在分泌过量胰岛素的肿瘤(称为胰岛素瘤),儿童胰腺中先天性β细胞增生,成人非胰岛素瘤性胰腺源性低血糖综合征。
病人和方法:20例因这种低血糖综合征而手术的患者的临床特征和手术结果;小儿胰岛素瘤为18例,奈瑟成纤维细胞为2例。
结果:8例胰岛素瘤位于胰头,其中2例位于胰头,其余8例在尾巴。手术技术为摘除9例,因可疑恶性肿瘤局部切除1例,远端胰腺切除术8例。两名患有神经纤维母细胞病的儿童均接受了85%的保留脾脏的胰腺切除术。该研究没有死亡率,但是三名患者的头部摘除后出现了低容量的胰瘘。
结论:诊断定位的阴性结果以及小尺寸的胰岛素瘤代表了成功手术的不良组合。术中超声检查是鉴别肿瘤的首选方法,因为它能够鉴别出不可触及的病变。

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