无创性检查在胰岛素瘤定位诊断中的价值

Noninvasive examinations for localization of insulinoma

目的探讨无创性检查方法在胰岛素瘤定位诊断中的价值。方法回顾性分析北京协和医院2005年1月至2008年11月手术治疗的88例胰岛素瘤患者的临床资料。其中男性40例，女性48例；年龄15～74岁，平均46．5岁。结果B超、增强CT、多排螺旋CT胰腺灌注、磁共振成像、奥曲肽显像、超声内镜、腹腔镜超声和术中超声的诊断阳性率分别为19．3％（17／88）、52．4％（11／21）、95．5％（64／67）、1／6、30．0％（6／20）、83．9％（26／31）、8／8和5／5。其中8例多发胰岛素瘤患者共切除肿瘤31个，多排螺旋CT胰腺灌注、术中超声的定位诊断准确率分别为48．4％（15／31）和100％（14／14）。结论目前胰岛素瘤的术前定位诊断已进入无创检查时代，应首选多排螺旋CT胰腺灌注。对于多发性胰岛素瘤的患者，术中超声在定位诊断中具有重要价值。

Objective To investigate the value of the noninvasive examinations for localization of insulinoma. Methods The clinical materials of 88 cases of insulinoma treated in Peking Union Medical College Hospital between January 2005 and November 2008 were analyzed retrospectively. There were 40 males and 48 females aged from 15 to 74 years old （averaged,46. 5 years old）. Results The positive rates for localization were 19.3% （ 17/88 ）, 52.4% （ 11/21 ）, 95.5% （ 64/67 ）, 1/6,30. 0% （ 6/20 ）, 83.9% （26/31） ,8/8 and 5/5 respectively in transabdominal ultrasound, enhanced CT, muhislice spiral CT pancreatic perfusion, MRI, somatostatin receptor scintigraphy, endoscopic ultrasound, laparoscopic ultrasound and intraoperative ultrasound. Thirty-one mutiple tumors in 8 patients were resected. The positive rates of locating the multiple insulinomas of multislice spiral CT pancreatic perfusion and Intraoperative Ultrasound were 48.4% （ 15/31 ） and 100% （14/14） respectively. Conclusions The locating diagnosis of insulinoma has came to noninvasive examination era. Muhislice spiral CT pancreatic perfusion is the first choice for localization. Intraoperative ultrasound might play an important role in locating tumors for patients with multiple insulinomas.