胰岛素瘤的诊治

Diagnosis and treatment of insulinoma

报告胰岛素瘤１８例，８例长期被误诊为癫痫（６例）或精神病（２例），误诊率高达４４４％。主要依据Ｗｈｉｐｐｌｅ三联征诊断。凡遇有精神病或癫痫样症状而治疗效果不明显的病人，即应疑及本病。术前经各种检查仍不能定位时，可根据临床表现行剖腹探查。最好行胰岛素瘤剜除术（ｅｎｕｃｌｅａｔｉｏｎ），必要时也可行胰十二指肠切除或胰体尾切除，但应尽量避免盲目性胰体尾及脾切除术。术后并发症为胰瘘、假性胰腺囊肿、腹腔脓肿。究其原因，可能是缝合创面过密。

Eighteen insulinomas were diagnosed based on Whipple triad.lt is advised that,in case patients suffer from refractory psychosis or epilepsy, insulinoma should be cautioned.lf all preoperative procedures give negative results ,but differential diagnosis is established,surgical exploration is suggested .Enucleation is the procedure of choice,if insulinoma is localized .lf necessary Whipple procedure or resection of the body and the tail is considered.But “blind” resection of pancreatic body and tail should be avoided. Postoperative complications such as pancreatic fistula, pheudocyst,and abscess in the abdomen are usually due to oversewing on the pancreas.