31例胰岛素瘤临床及定位诊断分析

Clinical Analysis of Insulinoma Thirty-one Cases Report and Literature Review

目的 提高对胰岛素瘤的认识、诊断和治疗。方法 对31例胰岛素瘤患者的临床资料和定位诊断进行总结分析。结果 患者病程3周-14年，23例手术治疗，术后病理诊断为胰岛细胞瘤，其中2例多发内分泌腺瘤（MEN-1型）。8例未行手术治疗，经临床检查诊断为胰岛素瘤。31例中有28例有典型的Whipple三联症，住院期间低血糖发作，血糖在0．57—2．7mmol／L之间。23例INS（血浆胰岛素）／C（血糖）〉0．3。影像学检查阳性率：超声检查为53．3％，CT为50％，血管造影（DSA）为78．9％，内镜超声（EUS）为91．6％。结论 胰岛素瘤患者常反复发作低血糖、有各种交感神经兴奋及神经精神症状，影像学检查以EUS、DSA检出率为高。尤其EUS检查创伤小，阳性率高，应作为临床胰岛素瘤定位诊断的主要手段之一。

Objective To improve the clinical recognition and diagnosis ability for Insulinoma. Methods Thirty one cases with Insulinoma were reviewed and analyzed retrospectively. Results The duration before diagnosis was 3 weeks to 14 years. Among them,23 cases were performed operation and pathologic examination revealed Insulinoma,including two cases with MEN-1. Eight cases were not treated surgically in our hospital due to economic condition. There were 28 cases presented hypoglycemia with the minimum plasma glucose level of 0. 57-2. 7mmol/L. The positive rate for tumor localization of ultrasonography,CT,digital abstract angiography （DSA） and endoscopic ultrasonography （EUS） was 53.3% ,50%, 78.9% and 91.6% respectively. Conclusion Patients with Insulinoma usually present fasting hypoglycemia with adrenergic symptoms and central nervous system dysfunction. The EUS and DSA have higher positive rate for localizing the tumor, and especially EUS is a non-invasive and sensitive way to detect the tumor. It should be one of the first-line image medality for the localizing diagnosis of Insulinoma.