胰岛素瘤(附21例报告)

Insulinoma (a report of 21 cases)

目的探讨胰岛素瘤的术前定位方法与术中决策。方法对１９８２～１９９８年外科治疗的２１例胰岛素瘤进行回顾性分析。结果全组２１例，女１９例（９０５％），男２例。年龄中位数为３６岁。术前均明确诊断为胰岛素瘤。但曾误诊癫痫７例，精神病２例，误诊率４２８％。Ｂ超定位准确者７５％，ＣＴ定位准确者５０％。结论胰岛素瘤定位较困难；Ｂ超、ＣＴ是术前较为实用的定位检查方法；如经各种检查仍不能定位时，可根据临床表现施行剖腹探查。手术方式首选胰岛素瘤剜除术，必要时也可行胰十二指肠切除或胰体尾切除。对无法彻底切除的恶性胰岛细胞瘤，应尽量切除原发和转移病灶。

Objective To study the value of preoperative localization and Intraoperative strategy of insulinoma. Methods The clinical data of twenty one cases treated between 1982 and 1998 were reviewed. Results 19 women and 2 men with median age of 36 years old in this series, 9 (42.8%) patients were misdiagnosed as epilepsy or psychosis before admission to our hospital. The correct preoperative localization by BUS was 75% and by CT 50%. Conclusions Diagnosis of insulinoma may be made based on Whipple's triad, but preoperative localization is difficult. BUS and CT are good methods of preoperative localization. Enucleation is the choice of treatment when insulinoma is localized. Sometimes duodenopancreatectomy and resection of pancreatic tail are needed. For malignancy, if a radical resection can not be performed, resection of the tumor and metastasis must be done as possible.