超声引导下胰岛细胞瘤精细切除的临床研究

Clinical research of intraoperative ultrasound guided precise resection for insulinoma

目的探讨在术中B超引导下胰岛细胞瘤精确切除术的临床价值。方法对我院2000.1-2013.9近13年间收治的22例胰岛细胞瘤患者的临床特点、诊断和治疗方法进行回顾性分析总结。结果 22例患者中功能性胰岛细胞瘤占17例,无功能性5例;前者的主要表现为各种各样的低血糖症状,均有典型的Whipple三联征;后者主要是腹部包块就诊。血清胰岛素测定对诊断功能性胰岛细胞瘤有重要价值。22例经腹B超发现10例(45.5%),17例患者术前行CT检查,阳性率76.5%(13/17),而薄层CT扫描的敏感性可达91.7%(11/12)。术中B超阳性率100%(19/19),14例采用非精确切除发生胰瘘6例,8例采用术中在B超引导下对功能性胰岛细胞瘤患者实施精确切除胰瘘1例,超声引导下胰岛细胞瘤精确切除术可有效降低术后胰瘘发生率及胰瘘的严重程度(P<0.05)。结论典型的临床表现、CT薄层扫描、结合胰岛素水平测定是诊断胰岛细胞瘤诊断的有效方法;术中超声不仅有助于术中肿瘤的定位,超声引导下精确切除肿瘤,最大限度的保留正常胰腺组织可有效降低术后并发症。

Objective to explore the clinical value of B intraoperative ultrasound guided precise resection for islet cell tumors.Methods The clinical presentations insulinoma of 22 cases in our hospitals from 2000 to 2013 summarized retrospectively.and the diagnostic and therapeutical measures analyzed.Results 17 functioning and 5 nonfunctioning cases were collected.The key clinical symptom of functioning patients was various hypoglycemia but all accompanied typical Whipple tread syndrome,while non-functioning tumors was the abdomen mass.The pre-operation sensitivity of ultrasound was 45.5％.CT was 76.5％.thin slice CT scanning was 91.7％.Ultrasound in operation was 100％,pancreatic fistula developed in 6 patients under non-precise resection technique in treatment of 14 cases.And 1 occurred in 8 patients for precise resection technique under ultrasound,postoperative complications can effectively reduced the incidence of pancreatic fistula and the severity of pancreatic fistulain patients within precise resection under ultrasound （P ＜ 0.05）.Conclusion The typical clinical presentations,thin slice CT scanning,and the serum insulin level were the effective measures for the diagnosis of insulinoma.Intraoperative ultrasound not only can precise position,precise resection technique under intraoperative ultrasoundin can also preserve functional pancreatic tissue maximize,which deserved to spread.