胰岛素瘤17例临床诊治分析

Diagnosis and treatment of insulinoma:analysis of 17 cases

目的 探讨胰岛素瘤的诊断和治疗方法。 方法 回顾性地分析我院自 196 6年 ～ 2 0 0 0年收治的 17例胰岛素瘤。 结果 胰腺 B超、腹部 CT、选择性腹腔动脉造影检查准确率分别为 82 .4 %、72 .7%、6 0 %。2例未手术 ,15例肿瘤切除。肿瘤位于胰头钩突 3例 ,胰颈 1例 ,胰体尾 11例 ;80 %肿瘤直径 <3cm;行单纯肿瘤摘除术 8例 ,胰体尾切除术 4例 ,胰体尾加脾脏切除者 2例 ,胰腺节段性切除(捆绑式胰体尾空肠吻合空肠端侧吻合术 ) 1例。 结论 血糖、血胰岛素水平测定结合胰腺 B超、CT检查能有效提高功能性胰岛素瘤的诊断。治疗多为单纯性肿瘤切除 ,恶性肿瘤应行根治性切除 ,腹腔镜微创手术正处于尝试阶段 ,药物治疗仍然在探讨阶段。

Objective To discuss the diagnosis and treatment of insulinoma. Methods 17 patients with insulinoma admitted from 1966 to 2000 were analyzed retrospectively. Results Accurate localization rates of ultrasound,CT and angiography examinations were 82.4%,72.7%,and 60%,respectively. The tumors were located in the pancreas head in 3 cases,in the pnacreas neck in 1 case,and in the pancreas body and tail in 11 cases. The tumors were smaller than 3 cm in diameter in 80% cases. Local excision was performed in 8 cases,distal pancreatectomy in 4 cases,pancreatectomy plus splenectomy in 2 cases,and segmental pancreatectomy in 1 case. Conclusions Determination of blood sugar,blood insulin,ultrasound and CT can enhance the diagnosis of insulinoma. Local dissection may be enough for benign insulinoma,and radical operation should be considered,for malignant insulinoma. Laparoscopic surgery is tentative. Pharmaceutical therapy for insulinoma is on the way.