18例胰岛细胞瘤的临床特点及诊治体会

Clinical Features and Diagnosis and Treatment Experience of 18 Patients with Islet Cell Tumor

目的探讨胰岛细胞瘤的临床特点、诊治方法及转归。方法回顾性分析2000年1月—2013年4月北京大学第一医院收治的18例胰岛细胞瘤患者的临床特点、诊断和治疗方法、转归等资料。结果 18例患者中,男女比为1∶2;年龄为18~83岁,中位年龄51岁。16例为功能性胰岛细胞瘤,2例为无功能性胰岛细胞瘤,功能性胰岛细胞瘤均为胰岛素瘤,其中2例合并糖尿病。胰岛素瘤患者临床上均有典型的Whipple三联征;血糖为0.85~2.56mmol/L,同时胰岛素水平>10 m U/L有16例,胰岛素释放指数>0.4有11例,胰岛素释放修正指数>100有14例。胰岛素瘤患者行B超检查11例,5例阳性;行增强CT检查14例,11例阳性。行B超、CT检查均阴性的3例患者分别经胃镜超声、经皮经肝门静脉置管分段采血测定胰岛素(PTPC)、剖腹探查术中B超及分段采血方法进行诊断。17例胰岛细胞瘤患者行手术治疗,其中行肿瘤局部切除术10例,胰腺体尾部切除术6例,Whipple术式1例。患者术后均未出现严重并发症,胰岛素瘤患者术后低血糖均恢复。结论胰岛细胞瘤以功能性胰岛素瘤居多,少数合并糖尿病,确诊需有典型的Whipple三联征、胰岛素水平测定及胰岛素释放指数定性诊断,增强CT定位检查阳性率高。胰岛细胞瘤良性率高,治疗以外科手术为主。

Objective To investigate the clinical features,diagnosis,treatment,and outcome of the patients with islet cell tumor. Methods We conducted a retrospective analysis of the data about clinical features,diagnosis,treatment,and outcome of 18 cases with islet cell tumor admitted to Peking University First Hospital from January 2000 to April 2013. Results In the 18 patients,the male to female ratio was 1∶ 2; median age was 51 years（ between 18 and 83 years old）. Two cases had non-functioning islet cell tumor,the other 16 cases had insulinoma,a kind of functional islet cell tumor,including 2 cases accompanied with diabetes. Whipple＇s triad was found in all the patients with insulinoma： plasma glucose level was 0. 85-2. 56mmol/L and insulin value was 〉10 m U/L in all the patients measured at the time of the symptoms; insulin release index was 〉0. 4 in 11 cases and insulin release corrected index was 〉100 in 14 cases in the diagnosis of insulinoma. The positive of B ultrasonography in 5 cases and that of enhanced CT scan in 11 cases in tumor localization. Endoscopic ultrasonography,percutaneous transhepatic portal catheterization（ PTPC） segment sampling and B ultrasonography and segmental blood sampling during exploratory laparotomy were performed in 3 patients with negative B ultrasonography and CT scan for diagnosing the disease further. Surgical treatment was performed in 17 cases with islet cell tumor,specifically,local resection was carried out in 10 cases,resection of the body and tail of the pancreas was implemented in 6 cases,and Whipple procedure was performed in 1case. After surgery, no serious complications occurred in the patients and the plasma glucose levels of them returned.Conclusion The majority type of islet cell tumor is functional insulinoma, which is sometimes accompanied with diabetes.Whipple＇s triad and the measurement of serum insulin and insulin release index are needed in the diagnosis. Contrast-enhanced CT scan can be used in the localization with a high accuracy. Most patients are benign and can be cured with surgery.