Lečenje insulinoma pankreasa u Vojnomedicinskoj akademiji, Beograd: 60-godišnje iskustvo

  • Ivan Tavčar Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia
  • Saša Kiković Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia
  • Mihailo Bezmarević Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
  • Siniša Rusović Institute of Radiology, Military Medical Academy, Belgrade, Serbia
  • Nenad Perišić Clinic of Gastroenterology, Military Medical Academy, Belgrade, Serbia
  • Darko Mirković Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Adacemy, University of Belgrade, Belgrade, Serbia
  • Snežana Kuzmić-Janković Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia
  • Tamara Dragović Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Adacemy, University of Belgrade, Belgrade, Serbia
  • Jelena Karajović Clinic for Endocrinology, Military Medical Academy
  • Leposava Sekulović Institute of Radiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Adacemy, University of Belgrade, Belgrade, Serbia
  • Zoran Hajduković Clinic for Endocrinology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Adacemy, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/3757
Ključne reči: insulinoma||, ||insulinom, diagnosis||, ||dijagnoza, digestive system surgical procedures||, ||hirurgija digestivnog sistema, procedure, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod/Cilj. Insulinomi su retki, najčešće benigni tumori i najčešći endokrini tumori pankreasa. Širok spektar kliničkih manisfestacija kod bolesnika sa insulinomom razlog je za otežano otkrivanje bolesti sa dugim periodom od početka simptoma do postavljanja dijagnoze. Dijagnoza se postavlja na osnovu Whipple-ove trijade, 72-časovnog testa gladi i morfoloških ispitivanja. Terapija koja može dovesti do potpunog izlečenja je hirurško uklanjanje tumora. Metode. Retrospektivnom studijom obuhvaćeno je 42 bolesnika sa dijagnozom insulinoma, lečenih u našoj ustanovi u 60-godišnjem periodu. Kod svih bolesnika analizirane su demografske i kliničke karakteristike, načini postavljanja dijagnoze i dijagnostičke procedure za određivanje lokalizacije insulinoma. Procenjivana je veličina tumora i lokalizacija, vrsta hirurške intervencije, postoperativne komplikacije i ishod lečenja. Rezultati. Studijom je obuhvaćeno 42 bolesnika, 29 žena i 13 muškaraca. Medijana starosti u vreme postavljanja dijagnoze bila je 43 godine. Medijana vremena proteklog od početka simptoma do dijagnoze bila je tri godine. Najčešći klinički simptomi i znaci bili su poremećaji stanja svesti i ponašanja kod 73%, konfuzija i konvulzije kod 61% bolesnika. Dijagnoza insulinoma potvrđena je pomoću Whipple-ove trijade i 72-časovnog testa gladi kod 14 bolesnika. Lokalizacija insulinoma određena je angiografijom kod 16 (36%) bolesnika, ultrasonografijom (US) kod tri od 16 (18,8%) bolesnika, kompjuterizovanom tomografijom (KT) abdomena kod osam od 18 (44,5%) bolesnika i magnetnom rezonancijom (MR) kod dva od osam (25%) bolesnika. Insulinom je pronađen kod 13 od 13 (100%) bolesnika uz pomoć arterijske stimulacije sa venskim semplovanjem (ASVS) i kod 13 od 14 (93%) bolesnika pomoću endoskopske ultrasonografije (EUS). Od ukupno 42 bolesnika, 38 (90,5%) je operisano. Minimalna resekcija izvedena je kod 28 (73.6%) bolesnika [enukleacija tumora kod 27 (71%) i centralna pankreatektomija kod jednog (2.6%) bolesnika] i velika resekcija samo kod devet (23,6%) operisanih bolesnika [distalna splenopankreatektomija kod osam (21%) bolesnika i duodenopankreatektomija kod jednog (2,6%) bolesnika]. Ukupna stopa smrtnosti u postoperativnom periodu bila je 2,6% (jedan bolesnik). Zaključak. Kombinovanje ASVS i EUS kao dijagnostičke procedure omogućava veliku tačnost u preoperativnom određivanju lokalizacije insulinoma. Minimalna hirurška resekcija, kao što je enukleacija, trebalo bi da se sprovodi kada je god moguće.

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Objavljeno
2015/04/22
Broj časopisa
Vol. 71 Br. 3 (2014)
Rubrika
Originalni članak