摘要目的:总结腹腔镜手术治疗儿童高胰岛素血症的临床经验。方法:回顾性分析2016年1月至2022年12月复旦大学附属儿科医院78例先天性高胰岛素血症的患儿临床资料，其中男57例，女21例；入院时血糖平均值为2.7 mmol/L；手术的中位年龄为101 d。患儿因内科治疗无效接受腹腔镜下胰腺切除术，术式包括胰腺局部病灶切除、胰腺次全切除、胰头次全切除+胰腺管空肠吻合术。记录患儿的手术时间、术中出血量、术后开始进食时间、术后引流管拔除时间、术后住院时间、出院时血糖及术中术后输血情况等。出院后随访患儿血糖情况。结果:除2例患儿因病灶位置较深、出血中转开腹外，其余76例均在腹腔镜下顺利完成手术。21例患儿行局部病灶切除术，43例行胰腺次全切术，14例行胰头次全切除+胰腺管空肠吻合术。手术中位时间为118 min，术中中位出血量为5 ml，术后中位住院时间为17.5 d。出院时患儿血糖平均值为5.9 mmol/L；51例患儿血糖处在正常参考水平范围内，2例患儿血糖偏低，25例患儿血糖偏高。出院后16例患儿失访，其余患儿随访152~2 551 d，随访的中位时间为1 426 d。随访期间通过饮食可控制血糖的患儿有50例，包括局灶型病变患儿23例、弥漫型病变患儿23例、胰岛素瘤患儿4例。10例出现低血糖、2例出现高血糖，均需药物治疗。结论:对于内科治疗无效的高胰岛素血症患儿，建议腹腔镜下切除胰腺治疗。局灶型病变患儿术后血糖控制较好，弥漫型病变患儿切除90%~95%胰腺较为合适，术后效果不佳者仍需积极内科治疗以保持血糖稳定。

abstractsObjective:To summarize the clinical experience of laparoscopic surgery for the treatment of pediatric hyperinsulinemia.Methods:From January 2016 to December 2022, a total of 78 children with congenital hyperinsulinemia in Children's Hospital of Fudan University were retrospectively recruited for analyses, including 57 males and 21 females, with an average blood glucose on admission of 2.7 mmol/L and a median age of operation of 101 days. All of them were treated with laparoscopic pancreatectomy following a non-responsiveness to internal medicine. The surgical procedures included laparoscopic pancreatic local lesion resection, pancreatic subtotal resection, total pancreatic head resection and pancreaticojejunostomy. The operation time, intraoperative blood loss, postoperative feeding initiation, postoperative drainage tube removal, postoperative hospital stay, blood glucose level at discharge, and intraoperative and postoperative blood transfusion were statistically analyzed. The blood glucose after discharge was followed up.Results:Except for 2 patients who were converted to laparotomy due to deep lesion location and bleeding, the remaining 76 patients successfully completed the operation under laparoscopy. Twenty-one patients underwent local lesion resection, 43 patients underwent pancreatic subtotal resection, and 14 patients underwent total pancreatic head resection plus pancreaticojejunostomy. The median operation time, median intraoperative blood loss and median postoperative hospital stay were 118 min, 5 ml, and 17.5 days, respectively. The average blood glucose at discharge was 5.9 mmol/L. The blood glucose of 51 children was within the normal reference level, but low in 2 children and high in 25 children. After discharge, 16 pediatric patients lost to follow-up, and the median follow-up of the remaining patient was 1,426 (152-2,551) days. There were 50 children whose blood glucose could be controlled by diet, including 23 children with focal lesions, 23 children with diffuse lesions, and 4 children with insulinoma. Among the 23 children with diffuse lesions, 10 cases had hypoglycemia and 2 cases had hyperglycemia, all of which required drug treatment.Conclusions:For children with hyperinsulinemia and non-responsiveness to internal medicine, surgical resection is strongly recommended, and laparoscopic surgery is preferred. The prognosis of children who received focal lesion resection is satisfying. 90-95% extent of resection is more appropriate for the diffuse lesion. Patients with poor outcomes after operation still require active medical treatment.