胰岛素瘤的超声诊断:与其他诊断方法比较

目的:探讨超声等方法对胰岛素瘤的定位诊断价值。材料和方法:对42例经过手术和病理证实的胰岛素瘤患者术前定位诊断的各种方法进行回顾性分析,并与其他诊断方法对比分析其各自的定位符合率。结果:定位诊断符合率分别为B超31%(13/42)、EUS55.6%(5/9)、IOUS100%(10/10)、超声引导下PTPC100%(3/3)、CT59.5%(25/42)、MRI50%(6/12)、选择性DSA27.3%(3/11)及ASVS90%(9/10)。彩超(CDUS)对胰岛素瘤良、恶性有鉴别作用。结论:遵循循序渐进原则,先后选用B超(含CDUS)、EUS、CT等已可解决80%以上的定位诊断,然后再做MRI及ASVS;对仍未作出定位者,只要定性诊断明确即有手术探查指征,因为IOUS能提供可靠的定位信息。     

胰岛细胞瘤的外科诊治分析(附16例报告)

目的探讨胰岛细胞瘤的诊断和治疗方法。方法对我院2000年6月～2006年12月收治的胰岛细胞瘤16例的临床资料进行回顾性分析。结果本组16例经手术治疗,功能性胰岛细胞瘤13例术后血糖均恢复正常,非功能性细胞瘤3例术后腹部症状消失。术后发生并发症3例,经治疗后痊愈出院。结论术前、术中影像学检查可以提高手术切除率。手术切除胰岛细胞瘤可以获得满意效果。     

胰岛素瘤的诊断和治疗：附137例报告

目的总结胰岛素瘤的诊断方法和外科治疗效果。方法回顾性分析近26年来收治的胰岛素瘤137例患者的临床资料。结果男77例,女60例。137例均具有典型的Whipple三联症。B超,CT,MRI检查的阳性率分别为35.1%,67.9%,58.1%。126例手术治疗患者中,102例(80.9%)行胰岛素瘤摘除术,4例(3.2%)行胰十二指肠切除术,16例(12.7%)行胰体尾切除术,另外4例(3.2%)行开腹探查术。切除的122例肿瘤中,良性占96.7%,恶性3.3%;单发肿瘤98.4%,多发1.6%。86.9%肿瘤直径≤2.0cm。13.1%肿瘤位于胰头;位于胰体和胰尾者分别为46.7%和40.2%。结论Whipple三联症,结合IRI,IGR,C-肽,以及胰岛素原的检测水平,可作为胰岛素瘤的定性诊断依据。胰岛素瘤的定位诊断仍很困难,联合应用多种影像学检查方法有助于提高检出率。治疗首选肿瘤摘除术,如果术中探查未能找到肿瘤,不宜盲目行胰体尾切除术,应排除其他原因所致低血糖症,同时进一步完善影像学检查方法,明确定位后,再考虑二次手术治疗。     

选择性动脉钙刺激静脉采血检测胰岛素定位胰岛素瘤的临床研究

目的 研究选择性动脉钙刺激静脉采血(ASVS)检测胰岛素值定位胰岛素瘤的临床应用价值。方法 对连续10例定性诊断为胰岛素瘤的患者术前行ASVS检查。选择性插管至胃十二指肠动脉、肠系膜上动脉、脾动脉近段及远段，分别快速注入葡萄糖酸钙0．3g激发，于激发前后不同时相经肝静脉采血测胰岛素值。计算不同激发值与基础值之比值，取比值最高者为峰比值，认定峰比值最高的动脉所供应的胰腺区域为肿瘤所在区域。结果 ASVS准确定位率为90％，优于B超(30％)、超声内镜(43％)、CT(70％)、MRI(78％)及选择性血管造影(20％)。本组仅2例患者主诉轻度头晕、胸闷。结论 ASVS在胰岛素瘤的定位中较其他影像学检查有更高的准确性，尤其适合于诊断和定位困难的病例。快速注入小剂量钙剂能安全有效地激发肿瘤细胞分泌胰岛素产生峰值。以胰大动脉为界区分脾动脉近段与远段分别激发有助于胰尾肿瘤的定位。     

胰岛素瘤10例临床特点分析

目的 分析胰岛素瘤的临床表现特点，为诊断和治疗提供帮助。方法 回顾性分析2000年10月至2006年4月北京大学第一医院住院手术且术后病理诊断的胰岛素瘤10例临床资料。结果 （1）10例患者均表现有晨起或饥饿时发作性出冷汗、心慌等交感神经兴奋及头晕、乏力症状，其中9例进食或喝糖水后可缓解。9例有晕厥、昏迷等意识障碍，6例有惊厥、抽搐或癫痫发作，5例进食多且体重增加超过10kg。（2）8例血糖〈2．8mmol／L，7例胰岛素血糖比值〉0．4，9例胰岛素修正释放指数〉100。（3）B超、CT和术中探查阳性率分别为30％、60％和100％。结论 典型低血糖症状、Whipple三联症和胰岛素血糖比值、胰岛素修正释放指数是胰岛素瘤定性诊断主要依据，术中B超结合术中探查和脾门静脉分段取血是最有效的肿瘤定位手段。临床表现典型而影像学检查阴性病例应考虑剖腹探查术。     

Intra-operative quick insulin assay to confirm complete resection of insulinomas guided by selective arterial calcium injection (SACI)

Background and aims Insulinomas are rare endocrine disorders. Pre-operatively, conventional imaging techniques often fail to localise the tumor. In addition, due to the lack of quick insulin assays, intra-operative confirmation of complete resection was impossible until recently. Materials and methods Six patients with biochemical evidence of an insulinoma underwent pre-operative localisation studies and selective arterial calcium injection (SACI). In addition, insulin was measured before surgery and every 10–15 min after resection of the tumor using a quick insulin assay. Results Pre-operative localisation studies identified the tumor correctly as follows: endosonography: three of four, magnetic resonance imaging: two of four and SACI: six of six. Tumors in the head and body were enucleated while those in the tail were resected (n = 2, each). Those three patients, in whom magnetic resonance imaging and/or endosonography could localise the tumors pre-operatively, underwent laparoscopic surgery while the remaining three patients underwent open surgery. Intra-operatively, insulin dropped to normal levels within 20 min in all cases. After a follow-up of 0.8–3 years, all patients remained biochemically cured. Conclusions Pre-operatively, SACI appears to be a very sensitive localisation technique and may be most helpful in guiding the surgeon if conventional imaging techniques fail to localise the tumor. Complete removal of an insulinoma can be reliably predicted using a quick insulin assay. This paper was presented at the 2nd Biennial Meeting of the European Society of Endocrine Surgeons (ESES), May 18–20, 2006, Krakow, Poland.     

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目的总结胰岛素瘤的外科治疗经验。方法回顾性分析1983～2002年收治的128例胰岛素瘤的临床资料。结果肿瘤局部摘除术适用于75.8％的病人；胰瘘是胰岛素瘤手术后最常见的并发症。结论胰岛素瘤的手术方式应该根据病变的性质、部位、数量等因素决定；必要的术前定位检查有助于术中选择合理的手术方式。     

Comparison of benign and malignant insulinoma

BackgroundHow malignant insulinomas present relative to benign insulinomas is unknown.MethodsA single-institution retrospective study identified patients with insulinoma. Malignancy was defined by distant metastases, positive lymph node(s), T stage of 4, direct invasion into surrounding peripancreatic tissue, or presence of lymphovascular invasion. Wilcoxon Rank Sum tests and Kaplan-Meier analysis were used.ResultsA total of 311 patients were identified: 51 malignant and 260 benign. Patients with malignant insulinoma presented with higher levels of insulin, proinsulin, and c-peptide. Malignant lesions were larger: 4.2 ± 3.2 vs 1.8 ± 0.8 cm in benign lesions, p < 0.01. Overall survival at 5 years was 66.8% vs 95.4% for malignant and benign insulinoma respectively, p < 0.01.ConclusionsLarger size of insulinoma and increased serum β-cell polypeptide concentrations were associated with malignancy. Malignant insulinoma has poorer survival. Further work-up to rule out malignancy may be indicated for larger pancreatic lesions and for patients with higher pre-operative insulin and pro-insulin.     

动态血糖监测胰岛素瘤一例并文献复习

目的探讨动态血糖监测对胰岛素瘤术前诊断及术后疗效判断的价值。方法应用动态血糖监测系统(CGMS)对1例胰岛素瘤患者术前及术后分别进行连续3 d的血糖监测。结果①术前CGMS共累计监测血糖值871个,平均绝对差为12．9％,血糖的平均值、最高值、最低值分别为4．8、10．8和2．2 mmol/L;患者监测期间表现为夜间及餐前的反复低血糖,血糖<2．8 mmol/L及>7．8 mmol/L所占的时间百分比分别为 14％(595 min)和5％(215 min)。②术后CGMS监测显示患者血糖波动于3．5-7．7 mmol/L,平均血糖值为 5．1 mmol/L。结论动态血糖监测有助于胰岛素瘤的术前诊断及术后疗效判断。     

不同HIV蛋白酶抑制剂对鼠胰岛素瘤细胞功能的影响

目的：探讨不同HIV蛋白酶抑制剂对胰岛beta-细胞功能的影响。方珐：体外观察不同浓度ritonavir或amprenavir干预48h对鼠胰岛素瘤INS-1细胞葡萄糖刺激的胰岛素释放速率的影响，胰岛素测定采用ELISA法，并用细胞内DNA含量标准化。用苔盘蓝染色细胞计数、MTT试验评估ritonavir或amprenavir对INS-1细胞活力的影响。结果：Ritonavir治疗可以显著降低基础胰岛素分泌速率及葡萄糖刺激的胰岛素释放速率，并呈剂量依赖关系（r分别为-0．861，-0．839，均P〈0．01）。10μmol／L ritonavir分别降低基础胰岛素分泌和葡萄糖刺激的胰岛素释放达46％和47％。Amprenavir对胰岛素释放功能没有影响。结论：不同HIV蛋白酶抑制剂对胰岛beta-细胞功能的影响不同。