功能性胰岛素瘤临床诊治分析

目的:探讨功能性胰岛素瘤的临床诊断及外科治疗.方法:回顾性分析36例功能性胰岛素瘤患者的资料,术前以B超、CT、MRI、EUS进行定位检查,其中25例行术中B超(IOUS)检查.全组均行手术治疗,单纯肿瘤切除术32例,其中新方法(术前经ERCP行胰管插管,术中向胰管插管注入美蓝联合应用全频超声乳化吸引刀(CUSA)切除肿瘤)15例,传统方法(电刀切除)17例;胰体尾及脾切除术2例;胰腺中段切除、空肠胰体Roux-en-Y吻合术1例;胰十二指肠切除术1例.术后均经病理学检查确诊.结果:IOUS检查定位准确率明显高于术前影像学检查,差异有统计学意义(P＜ 0.05).新方法较传统方法相比,术后胰漏的发生率明显降低,差异有统计学意义(P＜ 0.05).结论:定位检查中,IOUS检查定位准确率最高.单纯肿瘤切除术中,术前经ERCP行胰管插管,术中向胰管插管注入美蓝联合应用CUSA切除肿瘤可明显降低术后胰漏的发生率.

Diagnosis and Treatment of Functional Insulinoma

Objective:To discuss the clinical diagnosis and surgical treatment of functional insulinoma.Methods Clinical data of 36 patients with functional insulinoma were analyzed retrospectively.Tumors in all patients were located by B ultrasound,CT,MRI and EUS preoperatively,25 of which had undergone intraoperative ultrasound.Various surgical procedures included 32 cases of insulinoma resection,15 of which were treated by new method preoperatively pancreatic duct intubation under ERCP,intraoperative combinating injecting methyleneblue and Caritational Ultrasonic Surgical Aspirator(CUSA)while 17 of which were treated by traditional method,2 cases of distal pancreatectomy and splenectomy,1 case of middle pancreatectomy and 1 case of pancreaticoduodenectomy.All cases were diagnostically confirmed by pathological examination.Results The location accuracy of 25 patients who had undergone intraoperative ultrasound was significantly higher than the preoperative imaging investigation(P < 0.05).Compared with the traditional surgery,The new method had significantly lower incidence of postoperative pancreatic leakage(P < 0.05).Conclusion Intraoperative ultrasound is recommended to be a routine diagnostic and location method for high accuracy.Preoperative pancreatic duct intubation under ERCP,intraoperative combination of injecting methylene blue and CUSA will reduce the morbidity of pancreatic leakage significantly.