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DOI: 10.1055/s-2005-863085
© Georg Thieme Verlag Stuttgart · New York
Minimal-invasive operative Therapie des organischen Hyperinsulinismus
Minimal-invasive operative treatment of organic hyperinsulinismPublication History
eingereicht: 25.1.2005
akzeptiert: 25.2.2005
Publication Date:
03 March 2005 (online)

Zusammenfassung
Hintergrund: Insulinome als Ursache des organischen Hyperinsulinismus sind in der Regel kleine, solitäre und gutartige endokrine Tumoren des Pankreas. Aufgrund einer inadäquaten autonomen Insulinsekretion führen sie zu Hypoglykämien und verursachen meist eine progressive Adipositas. Ihre operative Entfernung ermöglicht nahezu ohne Ausnahme eine Heilung. Wir berichten erstmals in der deutschsprachigen Literatur über die laparoskopische Therapie des organischen Hyperinsulinismus bei zwei Patienten.
Anamnese: Bei dem 15-jährigen Jungen traten vor 3 Jahren tonisch-klonische Krampfanfälle, Zittern und Heißhungerattacken als erste Symptome auf. Bei dem 50-jährigen Mann führten rezidivierende Schwächeanfälle zur stationären Abklärung.
Befunde: Bei dem Jungen betrug der Blutzucker während eines Hungertests 28 mg/dl, die Insulinkonzentration 15,9 µU/l und das C-Peptid 1,7 µg/l. Der insulinogene Index (Serum-Insulin/Serum-Glukose) lag bei 0,57. Bei dem Mann ergaben diese Messungen ebenfalls die Diagnose eines organischen Hyperinsulinismus. Konventionelle bildgebende Verfahren erbrachten keinen Tumornachweis; erst die Endosonographie ermöglichte die Diagnose einer 8 × 13 bzw. 10 × 9 mm großen Raumforderung im Pankreas.
Therapie und Verlauf: In beiden Fällen wurde ein laparoskopisches Vorgehen geplant und in Intubationsnarkose durchgeführt. Die Tumorenukleation gelang problemlos. Bei dem 50-jährigen Mann war aufgrund der Lage des Tumors am Pankreashauptgang eine Pankreaslinksresektion erforderlich und ebenfalls laparoskopisch möglich. Der postoperative Verlauf war ohne Komplikationen.
Folgerung: Es ist zu erwarten, dass die Technik der minimal-invasiven Entfernung von Insulinomen in Zukunft eine große Rolle spielen wird.
Summary
Background: Insulinomas are small, solitary and benign endocrine pancreatic tumours, causing organic hyperinsulinism by autonomous insulin-secretion. Episodes of severe hypoglycemia and progressive obesity are the most frequent clinical signs. Surgical resection of the tumours is always indicated for cure. Because the tumours are small and surgical trauma for adequate exposure of the pancreas is considerable, laparoscopic techniques to approach these tumours are attractive. On the occasion of two cases, this report describes the laparoscopic treatment of these rare tumors.
Anamnesis: Two male patients (15 years of age and 50 years of age) were admitted for seizures and symptoms of hypoglycaemia.
Findings: During fasting tests, both were diagnosed organic hyperinsulinism, with a blood glucose level of 28 mg/dl, insulin of 15.9 mU/ml and a c-peptide of 1.7 µg/l for an insulinogenic index of 0.57 determined in the young man. Similar values were obtained in the older man. Conventional imaging procedures were non diagnostic whereas endoscopic ultrasound of the pancreas revealed a 8 × 13 and 10 × 9 mm lesion in the pancreas.
Therapy and course: Laparoscopic resection of the tumor was attempted and accomplished in both patients. The young man underwent laparoscopic enucleation of the tumor, while the 50 year old man underwent left sided laparoscopic resection of the pancreas because the tumor was adjacent to the pancreatic duct. Postoperative course was uneventful in both cases.
Conclusion: It is to be expected, that this approach will receive increasing attention in the near future.
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Priv.-Doz. Dr. med. A. Zielke
Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Klinikum der Philipps-Universität
35043 Marburg
Phone: 06421/2866442
Fax: 06421/2866995
Email: zielke@mailer.uni-marburg.de