功能性胰岛β细胞瘤的外科诊治分析

Diagnosis and treatment of functional islet-β cell tumor

目的探讨功能性胰岛β细胞瘤的诊断和治疗方法。方法收集我院1998年4月至2008年4月收治的42例功能性胰岛β细胞瘤患者的临床资料,对其临床表现、检查手段和治疗结果进行回顾性分析。结果42例患者均有Whipple三联征,IRI/G>0.3有39例。术前行B超和CT检查,分别发现16例(38),32例(76),术前B超联合CT检查发现34例(81),术中B超联合扪诊发现40例(95)。肿瘤位于胰头15例,胰体12例,胰尾15例;术后病理证实良性肿瘤40例,胰岛细胞增生1例,恶性1例。单纯肿瘤切除25例;胰体尾联合脾切除6例;单纯胰体尾切除9例,1例联合左肾切除;胰十二指肠切除2例。术后胰漏5例,4例为肿瘤摘除者,1例为胰十二指肠切除。1例术后因多器官功能衰竭死亡。结论功能性胰岛β细胞瘤定位诊断尤其重要,术中B超是发现肿瘤较好的手段。手术方式取决于肿瘤大小和位置,合理的手术方式选择能减少术后并发症的发生。

Objective To approach the methods for diagnosis and treatment of functional islet - β cell tumor. Methods The clinical data of 42 cases of functional islet - β cell tumors who had been admitted to our hospital from April 1998 to April 2008 ,and clinical manifestations ,inspection methods and results of treatment were reviewed retrospectively. Results All 42 cases presented with the Wipple triad, and IRI/G 〉 0.3 in 39 cases. Before operation, B - ultrasound and CT examinations indicated 16 cases （38%） and 32 cases （76%） of functional islet -β cell tumor, respectively. Preoperative combined examinations of B - ultrasound and CT indicated 34 cases （81%） of functional islet -β cell tumor, lntraoperative B - ultrasound in combination with palpation indicated 40 cases （95%） of functional islet- β cell tumor. The tumors were located as follows：pancreas head （15 cases） ,pancreas body （12 cases） ,pancreas tail （ 15 cases）. Postoperative pathological examination confirmed 40 cases of benign insulinomas, 1 case of nesidioblastosis and 1 case of malignant tumors respectively. The surgical procedures included enucleation of insulinoma （25 cases）, pancreatectomy plus splenectomy （6 cases）, resection of insulinoma and distal pancreas （9 cases,including one receiving combined left kidney resection） and Whipple＇s operation （2 cases）. Postoperative pancreatic fistula occurred in 5 cases：4 cases subject to the enucleation of the tumor,and 1 case to the Whipple＇s operation. One case was died of multiple organ failure. Conclusion It is especially important to locate the functional islet -β cell tumor. Intraoperative B - ultrasound examination is a good way to locate insulinoma. Surgical procedures depend on the size and localization of the tumors, and the rational operation strategy can decrease the postoperative complications.