胰岛素瘤的诊断与治疗(附25例报告)

DIAGNOSIS AND TREATMENT OF INSULINOMA (ANALYSIS OF 25 CASES)

胰岛素瘤在临床上较为少见，作者通过对我院收治２５ 例患者的总结，进而探讨该病的定性、定位诊断及手术治疗。其中１０ 例患者具有 Ｗｈｉｐｐｌｅ 三联征表现并因此而得到早期诊断；１２ 例行选择性腹腔动脉造影，１０ 例明确肿瘤的部位，准确率为８３ ％ ，而Ｂ 超、ＣＴ 检查分别为１６ ％ （４／２５） ，４０ ％ （８／２０） 。２５ 例患者均实施手术治疗，５ 例行胰体尾切除，２０ 例行肿瘤摘除。１５ 例行术中血糖监测，切除肿瘤１ 小时后，血糖值均达到正常水平。因此我们认为，Ｗｈｉｐｐｌｅ 三联征是胰岛素瘤定性诊断的主要依据； 选择性腹腔动脉造影对定位诊断有重要价值；诊断一旦成立，应及时手术切除肿瘤，术中血糖监测是判断肿瘤是否完全切除的有效方法。

Diagnosis and surgical procedures were studied in this paper. Twenty five cases of insulinoma were treated surgically from 1970 to 1997, in which 10 patients had Whipple′s triad so that the early diagnosis could be made. The sites of tumours were found in 10 out of 12 undergoing. Selective celiac angiongraphy with the accuracy rate of 83%, but B ultrasonography and CT gave only 10% (4 out of 25) and 40%(8 out of 20) respectively. In this series, 5 cases underwent body tail pancreatectomy and 20 cases enucleation of insulinoma. Blood glucose levels were tested during operation in 15 cases, and they all reached the normal level one hour after the tumours were completely removed. The authors consider that Whipple′s triad is the main basis in diagnosis of insulinoma. The selective celiac angiongraphy play an important role in detecting and locating the tumour. If diagnosis is made, surgical operation should be taken. The blood glucose monitoring during operation is the hallmark for complete resection of insulinomas.