胰岛素瘤的诊断和治疗：附30例报告

目的:总结探讨胰岛素瘤的诊断和治疗方法。方法:回顾性分析近11年来治疗的30例胰岛素瘤的临床资料。结果:全组30例均表现Whipple三联征。术前B超，CT，MRI诊断的阳性率分别为34.8 %(8/23)， 58.3 %(7/12)，71.4 %(5/7)，术中B超诊断的阳性率为87.5 %(7/8)。单个肿瘤27例，多发性肿瘤3例。单发者，位于胰头8例,胰体7例,胰尾12例;多发者，1例2枚肿块均位于胰体，另2例均为2枚肿块分别位于胰体和胰尾。行肿瘤局部摘除术21例,胰体尾切除术6例，胰体尾切除术＋脾切除术2例，胰十二指肠切除术1例。良性肿瘤29例，恶性1例。术后胰瘘4例,均经充分引流后治愈。30例术后低血糖症状均消失，随访27例，良性肿瘤术后4年复发1例，再次手术切除胰体肿块后治愈，恶性肿瘤术后3年复发，因腹腔转移死亡。结论:Whipple三联征,测定IRI/G比值是定性诊断的主要依据,术中扪诊联合术中B超是最有效的肿瘤定位手段,肿瘤摘除术仍为胰岛素瘤的主要术式。

Diagnosis and treatment of insulinoma: a report of 30 cases

Abstract:Objective:To discuss the diagnosis and treatment of insulinoma.Methods :The clinical data of 30 patients with insulinoma were reviewed.Results:All patients had Whipple′s triad.Accurate preoperative localization rate of B ultrasonography, CT and MRI was 34.8 %(8/23),58.3 %(7/12) and 71.4 %(5/7)，respectively. Localization rate of intraoperative ultrasonography (IOUS) was 87.5 %(7/8). The tumors were single in 27 cases,and multiple in 3 cases. In the location of single tumor,8 of them were in the head,7 in the body, and 12 in the tail; while for multiple tumors, 2 tumors were both located in the body in 1 patient,and 2 tumors were separately located in the body and tail respectively in 2 patients. Local enucleation was performed in 21 cases, distal pancreatectomy in 6 cases,distal pancreatectomy plus splenectomy in 2 cases,and duodenopancreatectomy in 1 case. The tumor was benign in 29 cases, and malignant in 1 case.Pancreatic fistula developed after operation in 4 cases, and in all cases, it healed after drainage. All patients had no symptoms of hypoglycemia after operation. At follow-up visit in 27 cases, 1 case of benign tumor recurred 4 years after operation, and was cured by resection of the pancreas body with tumor; the malignant tumor case, recurred and died of metastasis of abdominal cavity 3 years after operation.Conclusions:Whipple′s triad, and the ratio of immunoreactive insulin to blood glucose （IRI/G）are the bases for qualitative diagnosis of insulinoma. Meticulously palpating the gland combined with IOUS during operation is the most effective method for accurate tumor localization. Enucleation is the main mode of surgical treatment of insuinoma.