16例胰岛素瘤的诊断及治疗

Diagnosis and treatment of insulinoma in 16 cases

目的分析探讨胰岛素瘤的诊断方法和治疗措施。方法回顾性分析重庆市肿瘤研究所肝胆外科2008年12月至2015年12月收治的16例胰岛素瘤患者的临床治疗。结果所有患者均有典型的Whipple三联征。生化检查提示所有病例在发作期均有血糖降低及胰岛素升高,影像学检查有术前超声、增强CT、MRI、超声内镜(EUS)及术中超声(IOUS)。诊断阳性率分别为56.3%(9/16),77.8%(7/9),80.0%(8/10),100.0%(2/2),100.0%(5/5)。16例均接受手术治疗,其中局部切除6例,单纯胰体尾切除3例,胰体尾联合脾脏切除5例,胰十二指肠切除2例。所有病例在肿瘤被切除后血糖均明显上升。术后随访1~5年,未见复发和转移。结论胰岛素瘤的定位诊断首选CT和MRI,术中扪诊联合术中超声检查是术中定位的主要方法,手术切除是治疗该病的惟一有效方法。

Objective To analyze and investigate the diagnosis method and treatment measures of insulinoma.Methods The clinical data in 16 cases of insulinoma in the hepatobiliary surgery of our institute from Dec.2008 to Dec.2015 were retrospectively analyzed.Results All cases had typical Whipple′s triad,the biochemical examination suggested that all cases had plasma glucose decrease and plasma insulin increase during the onset period.The imaging examinations included preoperative ultrasonography,enhanced CT,MRI,EUS and intraoperative ultrasound（IOUS）.Their diagnosis positive rates were 56.3%（9/16）,77.8%（7/9）,80.0%（8/10）,100.0%（2/2）and 100.0%（5/5）respectively.Sixteen cases all received surgical treatment,including local tumor excision in 6cases,simple distal pancreatectomy in 3 cases,distal pancreatectomy plus splenectomy in 5 cases and pancreaticoduodenectomy（PD）in 2 cases.Plasma glucose level in all cases was significantly increased after tumor removal.Postoperative follow-up lasted for 1-5 years without recurrence and metastasis.Conclusion The first choice of insulinoma localization diagnosis is CT and MRI,intraoperative palpation combined with IOUS is the main method of intraoperative localization,and the surgical resection is the only effective method for treating this disease.