胰岛细胞瘤11例临床分析

目的通过分析胰岛素瘤和非功能性胰岛细胞瘤（NIT）的临床表现特点,探讨胰岛素瘤及NIT的诊断及治疗方法。方法对我院2005年5月至2010年4月收治的11例胰岛细胞瘤患者的临床资料进行回顾性研究,并结合国内外有关文献报道进行诊治分析。结果①男l例,女10例,年龄19~71岁,中位年龄45.4岁。其中7例有典型的Whipple三联征表现,发作时血糖〈2.8 mmol/L,空腹胰岛素与血糖（IRI/G）比值〉0.3;4例无特殊临床表现,于体检时发现包块。②影像学检查患者行超声、CT、MRI、数字减影血管造影（DSA）检查中之一项或几项,胰岛素瘤检出阳性率以MRI最高为80.0%（4/5）,NIT对影像学检查敏感。③7例手术治疗,均为单发病灶,肿瘤位于胰头3例,胰腺勾突部1例,胰头颈交接部2例,胰尾1例。3例胰岛素瘤手术后血糖立即恢复正常,有效率达100%。术后经病理证实7例均为良性胰岛细胞瘤。1例并发胆肠吻合口瘘合并营养不良及双侧肺部感染,2个月后痊愈。结论胰岛素瘤患者以典型的Whipple三联征为主要表现,发作时IRI/G比值对其发现具有很高的敏感度和特异度,术前CT、MRI及DSA联合可明确定位。NIT则由于无特异临床表现,不易早期诊断;但其对影像学检查较为敏感。胰岛素瘤及NIT一经发现均需早期手术治疗,以减少长期低血糖对脑组织造成不可逆性损害,以及减少肿瘤对周围组织的长期压迫和转移。

Clinical analysis on 11 cases of insulinoma

Objective According to clinical manifestation characteristics of insulinoma and nonfunctioning islet cell tumors（NIT）,to approach the diagnosis and treatment to insulinoma and NIT.Methods Retrospective analysis included 11 cases of insulinoma patients during May 2005 and April 2010,and the data were combined with records home and abroad for diagnosis and treatment analysis.Results ①The sex was 1 man,10 women,age from 19 to 71 years old,median age 45.4 years old.There were typical Whipple triad in 7 cases,whose blood glucose level was less than 2.8 mmol/L at onset,IRI/G was less than 0.3.There was no special clinical manifestations in 4 cases.The blocks were found in health examination.②Iconography examination in one or several ways such as ultrasound,CT,MRI,DSA,the highest insulinoma check out rate was 80.0% with MRI.NIT was sensitive to iconography.③Seven cases proceeded operations,all of which were single focus,tumor in head of pancreas 3 cases,in pancreas hook 1 case,in connection of pancreas head and neck 2 cases,in tail of pancreas 1 case.Blood glucose level in 3 cases returned to normal immediately after operation,the efficiency was 100%.After operation,pathology verified that iconographies in 7 cases were benign.1 case had biliary-enteric fistula combined malnutrition and two sides lung infection,and recovered after two months.Conclusion Whipple triad is the main performance of iconography patients,the rate IRI/G is highly sensitive and specific in attack.Before operation,combined CT,MRI and DSA can clearly locate the iconography.For no special clinical performance,NIT can not be diagnosed in early stage.Non-pain or increasing-pain abdominal block appears and bigger block can oppress surrounding tissue organ.But NIT is sensitive to iconography.Insulinoma and NIT should have operation treatment once found to reduce brain tissue irreversible damage because of long time hypoglycemia,in the mean while to reduce tumor＇s oppression to surrounding tissue and transferation.