胰岛素瘤的诊断和外科治疗

Diagnosis and surgical treatment of insulinoma

目的探讨胰岛素瘤的诊断和外科治疗方法。方法回顾性分析经手术和病理确诊的55例胰岛素瘤患者的临床资料。结果 7例为无功能性,48例(87.27%)功能性胰岛素瘤均有典型的Whipple三联征表现,且血胰岛素/血糖比值(IRI/G)>0.3。术前超声,CT,MRI,内镜超声(EUS),术中超声和选择性动脉造影(DSA)诊断的阳性率分别为83.64%(46/55),62.07%(18/29),40.00%(4/10),100%(8/8),90.00%(9/10)和40.00%(2/5)。胰岛素瘤剜除术48例次,胰体尾切除术5例,胰体尾联合脾切除术3例,胰腺中段切除术1例,胰十二指肠切除术1例;肿瘤直径小于或等于2 cm者占95.00%(57个)。23.33%(14个)的肿瘤位于胰头部,33.33%(20个)位于胰体部,43.33%(26个)位于胰尾部,3例(5.46%)为多发性肿瘤。病理诊断均为胰岛素瘤,无恶性者。术后无低血糖症状发作,发生胰瘘1例。结论 Whipple三联征和IRI/G>0.3可作为胰岛素瘤定性诊断的依据。联合应用超声,CT,MRI和内镜超声多种方法进行术前定位。内镜超声在胰岛细胞瘤定位诊断中的阳性率最高;术中超声是有效的定位方法。肿瘤剜除术是胰岛素瘤的最佳治疗方法。

Objective To study the methods used for diagnosis and surgical treatment of insulinoma.Methods We retrospectively analyzed 55 cases of insulinoma treated in our hospital from 1988 to 2009.Results Of the 55 cases,7 of non-functional insulinoma,48（87.27%） had typical Whipple′s triad and the IRI/G was greater than 0.3,and were diagnosed as functional insulinoma.The diagnostic sensitivity of transabdominal ultrasonography was 83.64%（46/55）,CT was 62.07%（18/29）,MIR was 40.00%（4/10）,endoscopic ultrasonography was 100%（8/8）,intraoperative ultrasonography was 90.00%（9/10） and DSA was 40%（2/5）.Simple enucleation was performed in 48 patient-times,resection of pancreatic body and tail（or just tail） in 5 cases,resection of pancreatic body and tail plus the spleen in 3 cases,central resection of pancreas in 1 case and pancreaticoduodenectomy in 1 case.The diameter of 95.00%（57） of tumors was ≤2 cm,and 23.33%（14） tumors were located in the head of the pancreas,33.33%（20） in the body,and 43.33%（26） in the tail.Three patients had multiple tumors.All of the 55 cases were diagnosed as insulinoma pathologically.None was malignant.After operation,blood glucose became normal in all cases but pancreatic fistula occurred in 1 case.Conclusions Whipple′s triad and IRI/G0.3 is the main basis for the qualitative diagnosis of insulinmoma.Combined methods including Ultrasonography,CT,MIR,and endoscopic ultrasonography should be used for localization diagnosis before operation.The positive localization rate of endoscopic ultrasonography is the highest.The application of intraoperative palpation and intraoperative ultrasonography shows great significance for insulinoma localization.Simple enucleation is the most common and optimal surgical method.