胰岛素瘤的定性、定位诊断及治疗分析

Qualitative diagnosis, localization diagnosis and treatment of insulinoma

目的:探讨胰岛素瘤的定性、定位诊断和治疗。方法:回顾性分析中国医科大学附属第一医院2005年1月—2014年9月收治的50例胰岛素瘤患者的临床资料。结果:50例患者中,男9例,女41例,有典型的Whipple三联征的患者占98%(49/50)。影像学定位诊断阳性率:腹部超声联合增强CT为91.7%(33/36),腹部超声联合MRI为85.7%(12/14),增强CT联合MRI为88.9%(8/9),腹部超声、增强CT、MRI联合检查为100%(7/7),胰腺灌注CT扫描为100%(13/13)、超声内镜(EUS)为100%(3/3),术中超声(IOUS)为50%(1/2)。38例患者行手术治疗切除肿瘤。结论:Whipple三联征、血清胰岛素水平是胰岛素瘤定性诊断的重要方法;胰腺增强CT联合腹部超声是术前定位诊断的首选方法,胰腺灌注CT、EUS检查是术前定位诊断中最准确的检查方法。定位检查顺序:B超→增强CT→MRI→灌注CT→EUS等。手术切除肿瘤是治疗胰岛素瘤的最佳治疗方案。

Objective： Explore and analyse the qualitative diagnosis,localization diagnosis and treatment of insulinoma. Methods： The clinical materials of 50 cases of insulinoma treated in the First Hospital of China Medical University between January 2005 and September 2014 were analysed retrospectively. Results： There were 9 males and 41 females, 98%（49/50）were characterized by typical Whipple triad.Accurate localization rate of B ultrasonography combined with enhanced CT,enhanced CT combined with MRI, B ultrasonography combined with enhanced CT MRI, CT pan-creatic perfusion, EUS and IOUS was 91.7.0%（33/36）,85.7%（12/14）,88.9%（8/9）,100%（7/7）,100%（13/13）,100%（3/3）,50%（1/2）respectively. 38 patients were underwent surgery. Conclusion：Whipple triad and serum insulin level are important method for qualitative diagnosis. Enhanced CT combined with B ultrasonography can be the first choice of preoperative localization diagnosis while CT pancreatic perfusion and EUS have the highest accuracy rate. Surgical resection is the best treatment for insulinoma.