胰岛素瘤诊治分析:附22例报告

Diagnosis and management of insulinoma: a report of 22 cases

目的:探讨胰岛素瘤的诊断和治疗。方法:对2008年1月—2013年1月收治并手术的22例胰岛素瘤患者的临床资料进行回顾性分析。结果:良性胰岛素瘤21例(95.5%),恶性1例(4.5%);患者均有不同程度的Whipple三联征表现,4例有不同程度的精神神经症状;检测空腹血胰岛素15例,胰岛素释放指数均>0.3;术前B超,CT,MRI,生长抑素受体显像的肿瘤检出情况分别为22.7%(5/22),54.5%(12/22),53.8%(7/13),100%(1/1),术中B超检出率为100%(10/10)。行肿瘤摘除术18例,胰体尾切除2例,胰体尾+脾切除2例。术后21例患者血糖恢复正常,1例术后仍有持续的低血糖症状,3个月后行二次手术探查发现位于胰腺钩突一肿瘤,切除后血糖恢复正常;l例术后仍留有精神神经症状;发生胰瘘1例,经充分引流和抑制胰腺分泌治疗于3周后痊愈。结论:Whipple三联征和胰岛素释放指数>0.3是胰岛素瘤定性诊断的主要依据。术前CT和MRI等检查定位+手术探查、术中B超定位是有效的定位诊断方法。手术是治愈胰岛素瘤最重要的方法。

Objective： To investigate the diagnosis and treatment ofinsulinoma. Methods： The clinical data of 22 patients with insulinoma admitted from 2008 to 2013 were retrospectively analyzed. Results： Of the patients, the lesion in 21 cases （95.5%） was benign, and only in one case （4.5%） was malignant. All patients had various degrees of the symptoms of Whipple＇s triad, and 4 cases had different types of neuropsychiatric symptoms. The measurement of fasting serum insulin was performed in 15 patients, in all of whom the insulin release index was higher than 0.3. The preoperative tumor detection by B-type ultrasound scan, CT examination, MRI and somatostatin receptor scintigraphy was 22.7% （5/22）, 54.5% （12/22）, 53.8% （7/13） and 100% （1/1）, and the detection rate of intraoperative B-ultrasound （IOUS） examination was 100% （10/10）, respectively. Tumor enucleation was performed in 18 patients, 2 patients underwent pancreatic body and tail resection and 2 patients received pancreatic body and tail resection plus splenectomy. After surgery, the blood sugar levels in 21 patients returned to normal, but one case showed persistent hypoglycemic symptoms due to a missed tumor located in the uncinate process of the pancreas which was found by a second surgical exploration done three months later, and then the patient became normoglycemia after tumor resection. The neuropsychiatric symptoms persisted in one patient. Pancreatic fistula occurred in one case, which was completely cured three weeks later by adequate drainage and inhibition of pancreatic secretion. Conclusion： Whipple＇s triad and insulin release index higher than 0.3 are the mainstay for the etiologic diagnosis of insulinoma, and preoperative CT and/or MRI plus surgical exploration and intraoperative ultrasound are sensitive for lesion localization. Surgical removal is the conventional treatment for this condition.