胰岛素瘤的诊断和治疗

Diagnosis and treatment of insulinoma

目的总结胰岛素瘤的诊断和治疗经验，以期提高手术成功率和改善预后。方法回顾性分析1966年至2007年收治的138例胰岛素瘤患者的临床资料。结果全组病例均有不同程度的低血糖症状和Whipple三联征表现；64例有不同程度的精神神经症状，12例术后血糖恢复正常，但仍遗留精神神经症状。检测空腹血胰岛素88例，胰岛素释放指数均〉0．3。术前B超检查75例，检出肿瘤8例；腹部CT68例，检出17例；腹部MRI检查10例，检出5例；术中B超44例，检出肿瘤43例，另1例病理证实为胰岛细胞增生症。135例行手术治疗，其中肿瘤摘除术88例，胰体尾切除44例，胰十二指肠切除2例，活检1例。132例术后血糖恢复正常。术后血糖反跳性升高110例，多于术后2周内恢复正常；术后胰瘘20例，急性胰腺炎32例。结论根据Whipple三联征和胰岛素释放指数对胰岛素瘤作出定性诊断。手术探查联合术中B超是简单有效的定位诊断方法。手术是治愈胰岛素瘤的惟一方法。术中B超引导下切除肿瘤可有效避免主胰管和血管的损伤，降低手术并发症。

Objective To summarize the diagnosis and therapeutic experience of insulinoma in order to improve the surgical success rate and prognosis. Methods The clinical data of 138 patients with insulinoma from 1966 to 2007 were retrospectively analyzed. Results In this group of patients, hypoglycemia of different levels and Whipple triad were detected. 64 patients expressed different psychic symptom, 12 patients＇ psychic symptom were still present after blood glucose normalized after operation. Fasting serum insulin values in 88 patients were measured, and the insulin release index was higher than 0. 3. Before operation, tumor was detected in 8 of 75 patients by B-ultrasound scan, and in 17 of 68 patients by CT, and in 5 of 10 patients by MRI. The intra-operative B-ultrasound （IOUS） examination was applied in 44 cases, and 43 cases were successfully detected. The operations included enucleation of insulinoma （ n = 88 ）, resection of the body and tail of pancreass （ n = 44）, pancreaticoduodenectomy （ n = 2 ）, and biopsy （ n = 1 ）. The blood glucose symptoms normalized postoperatively in 132 patients. The blood glucose rebound in 110 patients, but blood glucose normalized within 2 weeks. After operation, 20 patients developed pancreatic fistula, 32 patients developed acute pancreatitis. Conclusions Insulinoma could be qualitatively diagnosed according to Whipple triad and the insulin release index. Operations with IOUS were simple and effective methods to localize the tumors. The only way to cure insulinoma was operation, and IOUS guided operation could avoid main pancreatic duct and vessel injury, decrease post-operative complications.