51例胰岛细胞瘤的诊断和治疗

Diagnosis and treatment of $1 patients with pancreatic islet cell tumors

目的探讨胰岛细胞瘤的诊治经验。方法回顾性分析51例胰岛细胞瘤患者的临床特点、诊断和治疗方法。结果5l例患者中，38例胰岛素瘤患者均具有典型的Whipple三联征；13例无功能性胰岛细胞瘤患者中，无特异性临床症状5例，感上腹胀痛不适8例。术前超声检查、多排螺旋CT、磁共振成像（MRI）、超声内镜（EUS）的阳性率分别为43．1％、69．8％、62．5％和64．7％，与术中超声（IOUS）检查（96．3％）比较，差异均有统计学意义（均P〈0．05）。51例患者均行手术治疗，术后出现胰瘘6例，均经外引流、抗感染及营养支持治疗后痊愈。结论IOUS定位诊断的准确性高于术前超声、CT、MRI和EUS。治疗胰岛细胞瘤的有效方法是手术治疗。

Objective To investigate the diagnosis and treatment of pancreatic islet cell tumors. Methods Fifty-one patients with islet cell tumors treated in our department from January 1991 to April 2011 were included in this study. The data of clinical features, diagnosis and treatment were retrospectively analyzed. Results Among the 51 cases, 38 cases showed typical Whipple＇s triad, and the other 13 cases were non-functional islet cell tumors. In these 13 cases, 5 patients had no specific clinical symptoms, and 8 patients had abdominal distending pain. The positive rates of imaging were： B-ultrasound 43.1%, multi- slice spiral CT 69.8% ; MRI 62.5%, endoscopic ultrasonography （ EUS ） 64.7% （ 11/17 ）, and intraoperative ultrasound （IOUS） 96.3%, the differences among them were statistically significant （P 〈 0.05）. All patients underwent surgical treatment. Postoperative pancreatic leakage happened in 6 cases. Finally all the patients recovered after effective external drainage, anti-infection treatment and nutritional support. Conclusions Intraoperative ultrasonography （IOUS） has a higher accuracy in the diagnosis of pancreatic islet cell tumors, compared with preoperative B-ultrasonography, CT, MRI, and endoscopic ultrasound （EUS）. The most effective treatment of this disease is surgery.