胰岛素瘤定位诊断方法的选择与评价

目的分析胰岛素瘤定位诊断的方法，探讨合理选用的策略。方法对1990年1月至2005年2月北京协和医院收治的137例胰岛素瘤的临床资料进行回顾性分析。结果本组126例行手术治疗，除2例外术中均发现肿瘤，包括11例定性诊断明确，但无定位诊断的病人。术前BUS、EUS、CT、MRI、DSA和ASVS定位的阳性率分别为18．3％（23／126）、68．4％（13／19）、48．5％（48／99）、20％（3／15）、83．3％（70／84）和88．2％（15／17）。结论胰岛素瘤术前定位诊断有助于手术方式的选择，可首选相对无创的增强CT和EUS检查，仍然无法获得定位的病人可选择DSA或ASVS。对定性诊断明确的病人，无论能否获得定位诊断，均应及早手术探查，以免延误治疗。

Evaluation and selection of different methods for localization of insulinoma

Objective To analyze the localization procedures of insulinoma and explore the strategy of reasonable selection. Methods The clinical data of 137 patients with insulinoma treated in our hospital from January 1990 to February 2005 were retrospectively analyzed. Results In this group, 126 patients underwent surgical treatment. The tumor was found in all the 137 patients (including 11 without preoperative localization) but 2. The positive rate of preoperative localization by BUS, EUS, CT, MRI, DSA and ASVS was 18.3%(23/126), 68.4%(13/19), 48.5%(48/99), 20%(3/15), 83.3%(70/84)and 88.2%(15/17), respectively. Conclusions Localization of insulinoma is useful for selecting surgical procedure. Enhanced CT and EUS are of the first choice of imagine techniques, DSA and ASVS can be selected if noninvasive methods failed to localize tumors. Following definite diagnosis, surgical exploration is nevertheless advised, though in some cases satisfied localization is difficult to achieve.