Author/Editor		Repše, Stane
Title		Endokrini tumorji trebušne slinavke - naša kazuistika in kirurški problemi
Translated title		Endocrine tumours of the pancreas - own experience and surgical problems
Type		članek
Source		Gastroenterolog
Vol. and No.		Letnik 5, št. 1
Publication year		2001
Volume		str. 61-4
Language		slo
Abstract		Background. Due to small size, heterogeneous entities and sometimes unrealiable or even unsuccessfoul preoperative localisation endocrine pancreas tumours (EPT) represent a serious surgical problem. Patients and methods. Retrospective analysis of our-own series of 31 EPT patients: 24 insulinomas, 3 carcinods, 2 gastrinoma, 1 glucagonoma and 1 somatostatinoma. Type of surgery performed: insulinoma enucleation 15-times, left pancreatectomy 10times, pancreatoduadenectomy twice, segmental (central) pancreas resection once, tumor resection without pancreas resection (gastrinoma and glukagonoma) twice, right hepatectomy (metastases of gastrinoma) once. In four patients with malignant insulinomas and a female patient with carcinoid liver metastases were resected simultaneously. Results. There was no case of postoperative death. In 3 patients with enucleation of insulinoma from the head of pancreas secretion with excessive amylase values persisted in the side of drainage for a longer time; but it stopped spontaneously. In 3 patients percutaneous drainage of intraabdominal collection was necessary. One female patient developped pulmonary embolism. In 4 EIT patients recurency occurred one to 8 years after the first operation. All 4 patients underwent several operations and died due to tumour progression. There is no follow-up for 3 patients with malignant insulinoma with liver metastases (not Slovene residents). Conclusions: Accurate preoperative EPT localisation is the bases for successful surgery. Benign endocrine tumours should be enucleated; malignant ones require resection in the healthy tissue and removal of the metastases.
Summary		Izhodišča. Endokrini tumorji pankreasa (ETP) lahko pomenijo zaradi svoje majhnosti, možne multiplosti in včasih nezanesljive ali celo nemogoče natančne predoperativne lokalizacije hud kirurški problem. Bolniki in metode. Retrospektivna anaiiza lastne serije 31 bolnikov z ETP: 24 inzulinomov, 3 karcinoidi, 2 gastrinoma, 3 glukagonom in 1 somatostatinom. Vrste operacijskih posegov: 15-krat enukleacija tumorja (inzulinomi); 10-krat leva pankreatektomija, 2-krat cefatična pankreatoduodenektomija, 1 krat segmentna (centralna) resekcija pankreasa, 2-krat odstranitev tumorja brez resekcije pankreasa in 1-krat desna hepatektomija (gastrinom). Pri 4 bolnikih z inzulinomom in bolnici s karcinoidom smo sočasno resecirali tudi metastaze v jetrih. Rezultati. Pooperativne smrtnosti ni bilo. Pri treh operirancih z enukleacijo inzulinoma iz glave trebušne slinavke je dalj čase perzistirala sekrecija z zvišano amilazo na mestu drena, ki je spontano prenehala. Pri treh operirancih je bila potrebna perkutana drenaža intraabdominalne kolekcije. Pri eni bolnici se je pojavila pljučna embolija. Pri 4 bolnikih z ETP (karcinoid, gastrinom, glukagonom, inzulinom) se je pojavil recidiv med prvim in osmim letom po prvi operaciji. Vsi 4 bolniki so bili zaradi recidiva večkrat operirani in vsi so umrli zaradi napredovanja bolezni. Za tri izmed štirih bolnikov z malignim inzulinomom in metastazami v jetrih, ki niso prebivalci Slovenije, nimamo podatkov o preživetju. Sklep. Endokrine tumorje je treba pred operacijo natančno lokalizirati. Benigne je smiselno enukleirati, pri malignih pa je potrebna resecija dela pankreasa s tumorjem v zdravo. Svoje mesto ima tudi redukcijska kirurgija, saj lahko izboljša kakovost preostalega življenja.
Descriptors		PANCREATIC NEOPLASMS INSULINOMA GASTRINOMA CARCINOID TUMOR GLUCAGONOMA NEOPLASM RECURRENCE, LOCAL POSTOPERATIVE COMPLICATIONS