ABSTRACT
Objective To summarize the diagnosis and surgical therapeutic experience of functional insulinoma.Methods The clinical materials of 21 cases of functional insulinoma confirmed by pathologic examination from Jul.2006 to Aug.2016 were analyzed retrospectively.Results All patients showed signs of Whipple's triad.19.0％ of them were misdiagnosed at the first visit.Before surgery,insulin to glucose ratio(IRI/G)was calculated in all patients,which in 21 cases (100％) was higher than 0.3.The accuracy of preoperative tumor localization,detected by ultrasonography,CT and MRI,was 38.1％,91.67％ and 77.78％,respectively.Intraoperative ultrasound (IOUS) plus palpation was able to localize tumor in 100％ of the cases.All of the 21 cases were solitary,among which 1 case was malignant insulinoma which was diagnosed with the left lateral lobe metastasis (4.8％).All the 21 cases underwent surgery,among whom 8 cases (38.1％)underwent laparoscopic resection.There were 4 cases (19.0％) of pancreatic fistula.Conclusions IRI/G higher than 0.3 can be used as the main evidence for diagnosis of insulinoma in clinically suspected patients.Multislice spiral CT is the first choice for preoperative localization of insulinoma.The significance of intraoperative ultrasound localization should be paid more attention.Surgical management of insulinomas is considered to be the only curative method.Precise localization,minimally invasive surgery and damage control treatment will be the development trend in the future.
ABSTRACT
Objective To evaluate a combination hemihepatectomy and hilar blood vessel resection plus reconstruction for hilar cholangiocarcinoma. Methods Ten cases of hilar cholangiocarcinoma at the stage of Ⅲa, Ⅲb, and Ⅳ, underwent this surgical procedure including right - hemihepatectomy + pancreatoduodenectomy + right portal vein branch resection and reconstruction (1case), right - hemihepatectomy + right portal vein branch resection and reconstruction (5cases), left - hemihepatectomy + left caudectomy + left portal vein branch resection and reconstruction + left hepatic artery resection (1case), and left - hemihepatectomy + left caudectomy + left portal vein branch resection plus and reconstruction (3cases). Results There was no postoperative mortality and severe complications. All the 10 cases were followed up with 1,2,3-year survival rate of 50%,30%and 20%, respectively. Conclusion Hepatectomy plus hilar blood vessel resection and reconstruction helps to increase the resection rate in cases of hilar cholangiocarcinoma and prolong patients' survival.