85例胰岛素瘤的诊治分析

Experience in diagnosis and surgical Treatment of insulinoma:A Report of 85 Cases

对85例胰岛素瘤的诊断和治疗情况进行分析,认为Whipple三联征及胰岛素释放指数(IRI/G)>0.3可作为定性诊断的主要依据;对少数血糖>2.75mmol/L者,可结合饥饿试验进行诊断;胰岛素瘤多数直径较小,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,二者互为补充.对良性胰岛素瘤应力争行肿瘤摘除术,对肿瘤位于胰体尾,较大且深,或为多发肿瘤者,应行胰体尾切除术.

The preoperative diagnosis and surgical treatment of insulinomas in 85 cases were discussed in this paper. Whipple's triad and the ratio of immunoreactive insulin(μU/ml) to blood glucose(mg/dl)over 0. 3 were the basis for the qualitative diagnosis of insulinoma- Fasting test was helpful to make a correct diagnosis in the patients with the blood glucose level over 2. 75 mmol/L. In the majority of the cases,the diameter of the tumors was <2 cm,so preoperative localization was difficult. Carefully surgical exploration and palpation to the pancreas and intraoperative ultrasound imaging were main methods for the localization of insulinoma. Enucleation was the most commonly used procedure for the benign insulinomas;Distal resection of pancreatic body and tail was suitable for the patients with large,deep,or multiple tumors located in the pancreatic body and tail ,also for islet cell hyperplasia.