腹腔鏡部分胰臟摘除、淋巴結切除與肝採樣
手術醫師: 鄒天思/王郁盈/莊哲維
麻醉醫師: 林愷雯
門診內科醫師: 楊雨蓁
影像科醫師: 馬滋憶
➡️詳細的胰島素瘤與手術的衛教文章請見: jamesherriotah.com/health-surgery-17.html
病患是一隻10歲已絕育的米克斯犬。主訴為腳軟無法站立。抽血檢查後發現嚴重低血糖(血糖僅17)。進行身體檢查與影像學檢查時於超音波下懷疑有胰臟團塊，遂安排電腦斷層檢查。
電腦斷層檢查顯示有胰臟左葉團塊、淋巴結腫大與肝臟小結節。
手術前給予內科藥物控制血糖，並安排腹腔鏡部分胰臟切除、淋巴結切除與肝臟採樣。
腹腔鏡手術中施打靛氰綠造影，使用NIR/ICG定位淋巴結位置後移除。以能量器械封阻截斷左葉胰臟移除左葉胰臟。腹腔鏡檢查肝臟，於肝臟表面可見細小黃白結節，進行肝採樣。將胰臟與淋巴結置於檢體袋中移出腹腔。
移除腫瘤後術中血糖明顯上升。術後動物恢復順利並無胰臟炎等併發症。
術後病理切片顯示為胰島素瘤合併淋巴結與肝臟轉移。
-----------------------------------------------------------------------------------------------------------------------
Laparoscopic partial pancreatectomy and lymph node extirpation and liver biopsy
The patient is a 10-year-old neutered mixed dog. The chief complaint was the weakness of the hindlimb. The blood test revealed severe hypoglycemia (blood glucose was only 17). During the physical examination and imaging examination, a pancreatic mass was suspected under ultrasound, and a computed tomography examination was arranged.
Computed tomography showed a left pancreatic mass, prominent pancreaticoduodenal lymph node and multiple small nodules were found in the liver.
Medical drugs were given to control hypoglycemia before the surgery, and laparoscopic partial pancreatectomy, lymph node extirpation and liver biopsy were arranged.
Indocyanine green was injected into the pancreatic mass during a laparoscopic procedure, and NIR/ICG is used to locate the drainage lymph node before removal. The left lobe of the pancreas was sealed and amputated with a vascular sealing device. A small yellow-white nodule was noted on the liver surface, and a liver biopsy was performed. The pancreas and lymph nodes were removed in the specimen retrieval bag.
Blood glucose increased significantly during surgery after tumor removal. The animal recovered smoothly after surgery and no complications such as pancreatitis occurred.
The diagnosis was insulinoma with lymph node and liver metastasis.