Liang Qifeng,Wen Zhe,Liang Jinkun,et al.Clinical analysis of laparoscopic pancreatectomy for hyperinsulinism in infants[J].Journal of Clinical Pediatric Surgery,2026,(08):715-720.[doi:10.3760/cma.j.cn101785-20260517-00242]
腹腔镜胰腺切除术治疗婴儿先天性高胰岛素血症的临床分析
- Title:
- Clinical analysis of laparoscopic pancreatectomy for hyperinsulinism in infants
- Keywords:
- Congenital Hyperinsulinism; Laparoscopes; Pancreatectomy; Therapy; Prognosis; Operative Complications; Infant
- 摘要:
- 目的 探讨腹腔镜胰腺切除术治疗婴儿先天性高胰岛素血症（congenital hyperinsulinism，CHI）的可行性及中远期疗效。方法 本研究为回顾性病例系列分析。收集2015年11月至2024年10月在广州医科大学附属妇女儿童医疗中心肝胆外科接受腹腔镜手术治疗的12例CHI患儿临床资料，其中男10例、女2例，手术日龄43~394 d，中位手术日龄67 d。观察指标包括手术方式、中转开腹率、手术并发症、血糖水平等。结果 12例中，行腹腔镜胰腺次全切除术6例（切除95%者5例、切除98%者1例），腹腔镜胰腺部分切除术6例（胰头切除3例、胰颈切除1例、胰颈+部分胰头及胰体切除1例、胰体尾切除1例）。中转开腹3例。术中出现Henle干损伤出血1例，经静脉修补后痊愈。术后出现胰腺假囊肿1例、胆瘘1例，均经保守治疗后痊愈。无一例胰瘘发生。随访2~11年，中位随访时间55.5个月，11例血糖正常；1例偶发凌晨低血糖，进食后可缓解，无需药物治疗。结论 在具备丰富腹腔镜手术经验的医疗单位，腹腔镜胰腺切除术是治疗婴儿CHI的可行选择。局灶型CHI行胰腺部分切除术可获治愈，弥漫型CHI行95%胰腺次全切除术可获得良好的中远期血糖控制。
- Abstract:
- Objective To investigate the feasibility and mid-and long-term outcomes of laparoscopic pancreatectomy for congenital hyperinsulinism (CHI). Methods This retrospective case series included children with CHI who underwent laparoscopic surgery at Guangzhou Women and Children’s Medical Center,Guangzhou Medical University,between November 2015 and October 2024.The cohort comprised 10 boys and 2 girls.Age at surgery ranged from 43 to 394 days,with a median of 67 days.Outcomes evaluated included the surgical procedure,conversion to open surgery,surgical complications,and blood glucose levels. Results Among the 12 patients,6 underwent laparoscopic subtotal pancreatectomy,including 95% subtotal pancreatectomy in 5 patients and 98% pancreatectomy in 1 patient.The remaining 6 patients underwent laparoscopic partial pancreatectomy,including resection of the pancreatic head in 3 patients,pancreatic neck resection in 1,resection of the pancreatic neck with part of the pancreatic head and body in 1,and distal pancreatectomy in 1.Conversion to open surgery was required in 3 patients.Intraoperative injury to the gastrocolic trunk of Henle with bleeding occurred in 1 patient and was successfully managed by venous repair.Postoperative complications included pancreatic pseudocyst in 1 patient and bile leakage in 1 patient; both resolved with conservative treatment.No postoperative pancreatic fistula occurred.During a follow-up period of 2 to 11 years,with a median follow-up duration of 55.5 months,11 patients maintained normal blood glucose levels.One patient experienced occasional early-morning hypoglycemia,which resolved after feeding and did not require pharmacological treatment. Conclusion In medical centers with extensive laparoscopic experience,laparoscopic pancreatectomy is a feasible treatment option for infants with CHI.Partial pancreatectomy can achieve cure in focal CHI,whereas 95% subtotal pancreatectomy can provide favorable mid-and long-term glycemic control in diffuse CHI.
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备注/Memo
收稿日期:2026-5-17。
基金项目:广东省基础与应用基础研究项目(2024A1515013217)
通讯作者:温哲,Email:wenzhe2005@163.com