多发性胰岛素瘤的诊断与治疗

Diagnosis and treatment of multiple insulinoma

目的总结多发性胰岛素瘤的诊治经验。方法回顾性分析我院24年来收治的34例多发性胰岛素瘤患者的临床资料。结果34例患者发生37次多发性胰岛素瘤（3例两次发病均为多发性肿瘤）。2例为恶性胰岛素瘤。35．3％（12／34）的病例合并多发性内分泌肿瘤1型（MEN1）；5例次（13．5％，5／37）为胰岛素瘤合并胰岛细胞增生；16例次（43．2％，16／37）同时存在3个或3个以上的多发性胰岛素瘤；15例次（40．5％，15／37）既往曾发生漏诊；45．2％（57／126）的肿瘤直径小于1cm；88．9％（112／126）的肿瘤位于胰体尾部。多发肿瘤的局部摘除术适用于48．7％（18／37）的患者。结论多发性胰岛素瘤体积小，术前的定位检查发现全部肿瘤的阳性率低；对多发性胰岛素瘤的警惕，充分的术中探查，配合血糖监测、细针穿刺活检以及术中冰冻病理检查等措施有助于防止漏诊多发性胰岛素瘤。

Objective To summarize the diagnostic and therapeutic experiences for multiple insulinoma. Methods Clinical data of 34 cases of multiple insulinoma treated in Peking Union Medical College Hospital between 1984 and 2007 were analyzed retrospectively. Results Multiple insulinoma was identified in these 34 cases for 37 instances. Malignant insulinoma was found in 2 cases. Three cases suffered from postoperative recurrent multiple tumors. 35.3% cases belonged to MEN1 ; 13.5% cases were of insulinoma combined with islet hyperplasia; 43.2% cases had 3 or more than 3 insulinomas; Fifteen cases （40. 5% ） had had a misdiagnosis. 45.2% tumors were smaller than 1 cm in diameter; 88.9% multiple insulinoma located at the body and tail of the pancreas. Enucleation of multiple tumors was performed for 48.7 percent of cases. Conclusions Most multiple insulinomas were small, it was difficult for preoperative examination to locate all the tumors therefore. Being on the alert against multiple insulinoma and such measures as careful exploration, intraoperative blood glucose determination, fine needle aspiration biopsy, frozen sections helps to avoid missing multiple insulinoma.