胰岛素瘤误诊原因探讨和处理对策(附71例报告)

Misdiagnosis of insulinoma: Reasons and solutions

目的 分析胰岛素瘤误诊原因,探讨避免误诊、误治的策略。方法 对1990年1月至2001年9月北京协和医院收治的71例胰岛素瘤患者的临床资料进行回顾性分析。结果 本组患者从发病到确诊时间为3个月～30年,平均4.24年,1年内获得确诊者17例,占23.9％。93％的患者有被误诊的病史,最常见的误诊原因分别为反应性低血糖（38％）、癫痫（23.9％）、颅内病变（21.1％）和脑血管病（12.6％）;4.2％的患者被误诊为精神病。在获得确诊时,54.9％的患者有不同程度的记忆力下降,智力减退或反应迟钝。结论 Whipple三联征和胰岛素/血糖（I/G）>0.3是胰岛素瘤定性诊断的主要依据。提高对胰岛素瘤的警惕性,合理应用辅助检查,有助于减少误诊。对定性诊断明确的患者,无论能否获得定位诊断,均应及早手术探查,以免延误治疗。

Objective To analyze factors contributing to misdiagnosis of insulinoma and to work out a strategy to avoid possible mistakes. Methods The clinical materials of 71 patients with insulinoma treated in our hospital from January 1990 to September 2001 were retrospectively analyzed. Results In this group, the time needed for definite diagnosis ranged from 3 months to 30 years, with a mean of 4. 24 years. Only 23. 9% (17/71) patients got definite diagnosis within one year, 93% patients had a history of misdiagnosis, including functional hypoglycemia(38%), epilepsy (23.9%), intracranail disease (21.1%), cerebrovascular disease (12.6%) and psychopathy (4.2%). Meanwhile, 54.9% patients had undergone memory loss, intelligence retardation and reaction bluntness at the time when their conditions were confirmed as insulinoma. Conclusions Whipple triad and the ratio of insulin to glucose (>0.3) are the key points of diagnosis of insulinoma. Moreover, alertness to insulinoma and reasonable use of auxiliary examinations are helpful to avoid mistakes. Once the diagnosis is confirmed clinically, surgical exploration is advisable, although exact localization of the tumor may be difficult in some cases.