中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2011年
1期
13-16
,共4页
展翰翔%赵玉沛%张太平%丛林%廖泉%戴梦华
展翰翔%趙玉沛%張太平%叢林%廖泉%戴夢華
전한상%조옥패%장태평%총림%료천%대몽화
胰岛素瘤%血糖%外科治疗%MEN-Ⅰ
胰島素瘤%血糖%外科治療%MEN-Ⅰ
이도소류%혈당%외과치료%MEN-Ⅰ
Insulinoma%Glucose%Surgical treatment%Multiple endocrine neoplasia type 1
目的 了解胰岛素瘤患者围手术期血糖变化规律,指导临床诊断及治疗.方法 回顾性分析北京协和医院近20年手术治疗的胰岛素瘤病例资料,除外多次手术及手术未涉及胰腺患者.结果 共收集到完整病例资料245例,男性103例,女性142例.平均年龄(42.2±14.6)岁.术前平均空腹血糖水平(1.47土0.57)mmol/L,87.4%患者胰岛素/血糖比值大干0.3.术中切除肿瘤后血糖逐步升高,79.6%患者肿瘤切除后1 h血糖升至基础空腹血糖值2倍以上;其余患者血糖上升缓慢,至术后第1天早晨可达此标准.术后患者出现不同程度反跳性高血糖,后逐渐下降,至出院时患者血糖接近正常,均值为5.56 mmol/L.结论 胰岛素瘤患者血糖在围手术期经历了一个"低→高→正常"的变化过程,血糖监测结合术中B超、冰冻切片等技术可大大减少病灶残留率,避免再次手术,对于术后的反跳性高血糖应采用胰岛素泵积极调整,减少并发症的发生.
目的 瞭解胰島素瘤患者圍手術期血糖變化規律,指導臨床診斷及治療.方法 迴顧性分析北京協和醫院近20年手術治療的胰島素瘤病例資料,除外多次手術及手術未涉及胰腺患者.結果 共收集到完整病例資料245例,男性103例,女性142例.平均年齡(42.2±14.6)歲.術前平均空腹血糖水平(1.47土0.57)mmol/L,87.4%患者胰島素/血糖比值大榦0.3.術中切除腫瘤後血糖逐步升高,79.6%患者腫瘤切除後1 h血糖升至基礎空腹血糖值2倍以上;其餘患者血糖上升緩慢,至術後第1天早晨可達此標準.術後患者齣現不同程度反跳性高血糖,後逐漸下降,至齣院時患者血糖接近正常,均值為5.56 mmol/L.結論 胰島素瘤患者血糖在圍手術期經歷瞭一箇"低→高→正常"的變化過程,血糖鑑測結閤術中B超、冰凍切片等技術可大大減少病竈殘留率,避免再次手術,對于術後的反跳性高血糖應採用胰島素泵積極調整,減少併髮癥的髮生.
목적 료해이도소류환자위수술기혈당변화규률,지도림상진단급치료.방법 회고성분석북경협화의원근20년수술치료적이도소류병례자료,제외다차수술급수술미섭급이선환자.결과 공수집도완정병례자료245례,남성103례,녀성142례.평균년령(42.2±14.6)세.술전평균공복혈당수평(1.47토0.57)mmol/L,87.4%환자이도소/혈당비치대간0.3.술중절제종류후혈당축보승고,79.6%환자종류절제후1 h혈당승지기출공복혈당치2배이상;기여환자혈당상승완만,지술후제1천조신가체차표준.술후환자출현불동정도반도성고혈당,후축점하강,지출원시환자혈당접근정상,균치위5.56 mmol/L.결론 이도소류환자혈당재위수술기경력료일개"저→고→정상"적변화과정,혈당감측결합술중B초、빙동절편등기술가대대감소병조잔류솔,피면재차수술,대우술후적반도성고혈당응채용이도소빙적겁조정,감소병발증적발생.
Objective To retrospectively study the variation of glucose in patients with insulinomas. Methods The medical records of patients who underwent operations in the last 20 years at Peking Union Medical College Hospital were reviewed retrospectively. Patients who received repeated operations, or just exploratory laparotomy or liver biopsy were excluded. The clinical data were collected and analyzed. Results There were 245 patients, including 103 males and 142 females. The mean age was (42.2+ 14.6) years old. The mean value of preoperative fasting glucose was (1.47+0. 57) mmol/L, and the ratio of insulin to glucose was greater than 0.3 in 87.4% patients. The glucose level rose gradually after removal of the tumor(s). The blood sugar rising more than 1 time over the baseline value at one hour after resection was observed in 79.6% patients. For all the other patients, the glucose level rose to this level in the morning of the first postoperative Day 1. Rebound hyperglycemia was common after operations, and the glucose gradually returned to normal, with a mean level of 5.56 mmol/L at the time when the patients were discharged home. Conclusions Patients with insulinomas had a serum fluctuation in glucose (low→high→normal) during the perioperative period.Intraoperative glucose test combined with ultrasound and frozen section helped to localize and to remove all the lesions. Rebound hyperglycemia after surgery should be treated with insulin pump actively to minimize the incidence of complications.
