膵島細胞症における膵切除の経験

概要

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A 9-month-old infant was admitted because of hypoglycemic convulsion. Although about 85% of pancreas was resected under the diagnosis of hyperinsulinemic hypoglycemia, hypoglycemic attack that was resistant to medication recurred. The specimen histologically proved to be nesidioblastosis. Two months later, approximately 98% of pancreas was resected while small amount of pancreatic tissue between duodenum and common bile duct left intact. Two months postoperatively, the level of blood sugar was stabilized at normal range without administration of insulin and gradual psychomotor development was obtained. It is controversial about the adequate range of pancreatectomy for nesidioblastosis. The review of Japanese literature including our case provided the following results : In the patients who received pancreatectomy less than 90% for nesidioblastosis, the rate of recurrence of hypoglycemia was 53% and the rate of additional operation was 35%, whereas in the patients with pancreatectomy more than 90%, the rate of recurrence and reoperation was 17% respectively. In conclusion, we recommend that near total, over 95%, pancreas should be initially resected for nesidioblastosis.
日本小児外科学会の論文
1991-02-20