胰岛素瘤的诊断与治疗（附130例报告）

Diagnosis and treatment of insulinoma： 130 cases

目的 总结胰岛素瘤的诊治经验.方法 回顾分析1966年至2008年收治的130例胰岛素瘤的临床资料.结果 本组130例均有Whipple三联征表现,平均病程5.17年.37.7％的患者曾被误诊,仅43.8％患者在发病1年内得到正确诊断.术前超声、CT、MRI和ASVS的正确定位率分别为32.9％、70.6％、70.3％和88.9％.其中单发胰岛素瘤121例（93.1％）,多发胰岛素瘤4例（3.1％）,增生5例（3.8％）;良性病变127例（97.7％）,恶性胰岛素瘤3例（2.3％）.130例均行手术治疗,其中行胰岛素瘤摘除术89例.术后胰瘘发生率为19.2％,胰腺炎发生率为3.9％.结论 Whipple三联征具有定性诊断意义,胰腺薄层三期增强扫描仍是目前胰岛素瘤术前定位诊断的首选方法,ASVS则可作为常规影像学定位阴性的补充定位手段.手术摘除是目前最主要的治疗手段.

Objective To summarize the diagnosis and surgical therapeutic experience of insulinoma.Methods The clinical data of 130 patients with insulinoma confirmed by pathologic examination from 1966 to 2008 were analyzed retrospectively.Results All the patients had Whipple＇s triad.37.7％ were once misdiagnosed.Only 43.8 ％ were diagnosed correctly within one year after the onset of symptoms.The average time of evolution was 5.2 years.Ultrasonography,CT,MRI and ASVS were able to localize tumor in 32.9％,70.6％,70.3％ and 88.9％ of the cases,respectively.There were 121 cases （93.1％） of single insulinoma,4 cases （3.1％）of multiple insulinomas,and 5 cases（3.8％）of hyperplasia.127cases（97.7 ％）were benign and 3 cases （2.3 ％）were malignant insulinoma.All the 130 cases underwent surgery,among whom 89 cases were cured by enucleation of tumor.The principal postoperative complications were pancreatic fistula（19.2％） and pancreatitis（3.9％）.Conclusions Whipple＇s triad was with great significance to diagnose insulinoma.Multislice spiral CT is the first choice for preoperative localization of insulinoma and ASVS is an important complementary measure for localizing insulinomas not detected by CT or MRI.Simple enucleation is the most common surgical method.