胰岛素瘤的诊断和治疗:附120例报告

Diagnosis and treatment of insulinoma:a report of 120 cases

目的探讨胰岛素瘤的诊断与治疗方法。方法回顾性分析40年间收治的120例胰岛素瘤患者的临床资料。结果全组患者均有Whipple三联症的临床表现,血糖均<2.75mmol/L;75例空腹血清胰岛素>25μU/mL,平均(65±6.0)μU/mL。术前B超检查60例,2例发现肿瘤;CT检查50例,10例发现肿瘤;术中B超检查18例,16例与术中探查相符,1例发现了未能扪及的肿瘤。良性肿瘤112例,恶性肿瘤4例,胰岛细胞增生症4例。行单纯肿瘤摘除70例,行包括肿瘤在内的胰体尾脾切除44例,单纯胰体尾切除4例,活检2例。112例良性胰岛素瘤术后111例低血糖症状立即消失,1例术后仍有低血糖症状发作,通过再次手术时发现钩突部肿瘤,切除后治愈。继发胰瘘20例,均为肿瘤摘除者,其中14例经引流自愈,5例经手术治疗痊愈,1例因腹腔感染死亡。结论胰岛素瘤术前定位不易,术中探查及术中B超是发现肿瘤的主要手段;对良性者应力争行肿瘤摘除术,对肿瘤位于胰体尾较大且深或多发肿瘤者应行胰体尾切除术。

Objective To study the methods for diagnosis and treatment of insulinoma. Methods The clinical data of 120 patients with insulinoma who had been admitted to our hospital in the last 40 years were retrospectively reviewed. Results Fasting blood glucose values were less than 2. 75 mmol/L in all the patients. Fasting serum insulin values in 75 patients were higher than 25 o,U/mL, and the average was （65 ± 6.0 ）o,U/mL. Before operation, tumor was detected in 2 of 60 patients by ultrasound scan, and in 10 of 50 by CT. Among 18 patients who had intra-operative B-ultrasound examination, 16 positive cases were verified by intraoperative exploration ; and one case the tumor was not palpable but was found by intraoperative B-ultrasound examination. The operations included enucleation of insulinoma （ 70 patients ） , insulinoma resection and distal resection of the pancreas （ 44 ） , distal resection of the pancreas （ 4 ） , and biopsy （ 2 ）. The low blood glucose symptoms disappeared after the first operation in 111 of the 112 patients who had benign tumor. One case with benign tumor was cured by a second operation. Twenty patients developed pancreatic fistula after tumor enacleation, of them, 14 healed uneventfully after drainage, 5 were cured by operation, and 1 died of peritoneal infection. Conclusions Preoperative localization of insulinomas is difficult. Intraoperative exploration and ultrasound scan are the chief methods for the localization of insulinoma. Enucleation of insulinoma should be selected for benign tumor. Resections of the pancreatic body and tail is required for large, deep or multiple tumors.