胰岛素瘤的诊断和治疗体会

Clinical diagnosis and treatment of insulinoma

目的探讨胰岛素瘤诊断和治疗的方法。方法回顾性分析安徽医科大学附属省立医院1998年1月-2011年1月收治28例胰岛素瘤患者的临床资料。结果24例功能性胰岛素瘤患者均有典型Whipple三联征表现；无功能性胰岛细胞瘤4例。术前超声、CT和术中超声定位诊断阳性率分别为60．9％（14／23）、84．6％（22／26）和90％（9／10）。行单纯肿瘤摘除术17例，胰体尾切除术3例，胰体尾联合脾切除术8例。病理诊断均为胰岛素瘤，术后无低血糖症发作，术后5例患者发生胰瘘。结论多排螺旋CT薄层扫描是目前胰岛素瘤术前定位诊断的首选方法。术中B超是对术前胰岛素瘤定位的检验和补充，有利于胰岛素瘤的定位；术中血糖的检测是判断胰岛素瘤切除效果的重要指标。绝大多数胰岛素瘤可经手术摘除治愈。

Objective To explore the diagnosis and management of insulinoma. Methods Retrospectively an- alyzed 28 cases of insulinoma treated in Affiliated Provincial Hospital of Anhui Medical University from Jan 1998 to Jan 2011. Results Twenty-four cases of functional insulinoma had typical Whipple＇ s triad. Four cases were non- functional insulinoma. The diagnostic sensitivity of preoperative BUS, CT and intraoperative BUS was respectively 60.9% （ 14/23）, 84.6% （22/26） and 90% （9/10）. Simple tumor enucleation was performed in 17 cases, distal pancreatic resection was performed in 3 cases, resection of distal pancreas plus the spleen was performed in 8 cases. The final pathologically of insulinoma was presented in all of the 28 cases. Hypoglycemia disappeared after resection in all cases. Pancreatic fistula occurred in five patients. Conclusions Multi-slice spiral CT came to be the preferred preoperative examination for location of insulinoma. Intraoperative BUS is the supplement to preopera- tive location diagnosis, lntraoperative blood sugar test is main index to judge the effect of insulinoma resection. Most insulinomas can be cured by surgical resection.