胰岛素瘤的诊断及外科治疗探讨

A Research on the diagnosis and surgical treatment of insulinoma

目的:探讨胰岛素瘤的临床特征、诊断及外科治疗方法。方法:所有患者均行手术治疗,手术方式:肿瘤摘除术39例,胰腺中断切除术1例,胰腺远端切除术4例,胰腺尾联合脾切除术2例,胰十二指肠手术1例。结果:肿瘤位于胰头钩突部9例、胰体部25例、胰尾部13例,术中见肿瘤大小0.6～3.8cm,平均2.0cm,肿瘤呈单发43例,多发4例;良性胰岛素瘤42例,恶性胰岛素瘤5例。术后患者血糖均恢复正常,无手术死亡病例,亦无急性胰腺炎、大出血发生,2例发生胰瘘,1例发生假性囊肿,1例胰体胰岛素瘤摘除后第5年复发,探查又发现胰尾部肿瘤,再次摘除后治愈。随访6个月至5年,症状均未复发。结论:Whipple三联症、胰岛素释放指数(IRI/G)比值是定性诊断的主要依据,联合应用多种影像学检查方法有助于提高检出率,外科手术是治疗胰岛素瘤的有效方法。

Objective： This literature is to study the clinical symptoms, diagnosis and surgical treatment of insulinoma. Methods.. All patients received surgical treatments. Thereinto, 39 underwent tumorectomy, 1underwent pancreatectomy at the middle part of pancreas, 4 underwent distal pancreatectomy, 2 underwent pancreatic tail resection combined with splenectomy, and 1 underwent pancreaticoduodenal surgery. Result.Of the 47 cases, 9 were detected to be with tumor located in the pancreatic uncinate, 25 in pancreas, and 13 in the tail of pancreas. The tumor discovered in the surgery was 0.6 to 3.8 cm long, with an average length of 2.0 cm. 43 presented solitary tumor symptoms, and 4 presented multiple tumor symptoms~ besides, 42 were diagnosed to be with be- nign insulinoma and 5 to be with malignant insulinoma. Blood sugar levels of all postoperative patients had restored to normal and there were no death occurrence, no acute pancreatitis or massive hemorrhage occurrences~ in addition, 2 had pancreatic fistula, 1 had pancreatic pseudo cysts, and 1 relapsed 5 years later after the removal of insulinoma and was detected to have tumor in the tail of pancreas, and had been cured after another removal surgery. Patients had been followed up for 6 months to 5 years, and no recur- rence occurred. Conclusion ： Whipple triad and insulin release index are the main basis for qualitative diagnosis, and the combination of multiple imaging methods can help to improve the diagnosis rate. Besides, surgical treatment is an effective way for curing insuli- noma.