Artigos Nacionais - Resumo

Tratamento cirúrgico dos insulinomas. Estudo de 59 casos.
Autores: Machado, M.C.C.; Jukemura, J.; Cunha, J.E.M.; Penteado, S.; Bacchella, T.; Abdo, E.E.; Montagnini, A.L.; Herman, P.; Machado, M.A.C.; Pinotti, H.W.
Rev. Assoc. Med. Bras., 44(2): 159-66, 1998.

 

 

Após a confirmação clínica e laboratorial de hiperinsulinismo, o principal problema consiste na localização precisa da lesão no parênquima pancreático, propiciando tratamento cirúrgico adequado. Objetivo. Analisar os métodos utilizados para o diagnóstico e localização pré e intra-operatório dos insulinomas, bem como as técnicas e os resultados do tratamento cirúrgico. Métodos. Foram estudados 59 casos consecutivos de insulinoma submetidos à intervenção cirúrgica. Cada um dos métodos utilizados para a localização pré-operatória dessas lesões foi avaliado quanto à sua eficiência em confronto com os achados intra-operatórios. A palpação do pâncreas, isoladamente ou associada à ultra-sonografia intra-operatória, como métodos de localização dos insulinomas, foi também estudada. Os tipos de intervenção cirúrgica foram analisados quanto aos seus resultados imediatos e tardios. Resultados. Dos 59 insulinomas, 55 eram benignos e quatro, malignos. Dos métodos utilizados para a localização pré-operatória, a ultra-sonografia foi eficiente em 28,1% dos casos, a tomografia computadorizada em 25%, a ultra-sonografia endoscópica em 27,2%, a arteriografia seletiva em 54,1% e a colheita de amostras de sangue portal para dosagem de insulina em 94,4% dos casos. A palpação bidigital, durante a intervenção cirúrgica, localizou as lesões em 54/55 casos (98,2%). A ultra-sonografia intra-operatória foi decisiva em apenas um caso. Cinco doentes apresentavam neoplasia endócrina múltipla tipo I e em todos as lesões pancreáticas eram múltiplas. Foram efetuadas 29 enucleações e 32 ressecções pancreáticas nos doentes com lesões benignas. Os doentes com lesões malignas foram submetidos a ressecções pancreáticas e quimioterapia. Não houve mortalidade, porém observaram-se complicações (fístulas) em 29/59 casos. Os resultados foram bons em 98,1% dos doentes com lesões benignas. Apenas um dos doentes com lesões malignas sobreviveu cinco anos. Três doentes portadores de lesões benignas e submetidos a ressecções pancreáticas evoluíram com diabetes tardiamente. Conclusões. A localização pré-operatória não é absolutamente necessária desde que a palpação bidigital associada à ultra-sonografia intra-operatória permite a localização de todas as lesões . As enucleações devem ser utilizadas, quando possível, de preferência às ressecções pancreáticas nas lesões benignas. Constam do trabalho 4 tabelas, 4 figuras e 29 referências bibliográficas.

 
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