胰岛素瘤的诊治分析(附49例报告)

目的　评价胰岛素瘤的各种诊断方法和外科治疗方法。方法　回顾性分析我院 2 0年来诊治的 4 9例胰岛素瘤。结果　 4 5例病人均有典型的Whipple三联征表现 ,术前B超、CT、MRI、SA定性诊断的阳性率分别为 4 7 3%(18/ 38)、6 0 %(15 / 2 5 )、6 4 7%(11/ 17)、83 3%(5 / 6 ) ,手术探查的阳性发现率为 97 8%(44 / 4 5 ) ,术中B超为 10 0 %(12 / 12 )。肿瘤局部切除术 31例 ,胰尾切除术 4例 ,胰体尾切除术 7例 ,加做脾切除者 2例 ,Whipple手术 1例 ,PPPD手术 1例。结论　Whipple三联征和IRI/G >0 3可作为胰岛素瘤定性诊断的依据 ,胰岛素瘤的术前定位诊断较为困难 ,手术探查加术中B超检查是定位诊断的最佳方法。肿瘤局部摘除术是胰岛素瘤的最佳治疗方法 ,且其并发症最少。

Diagnosis and surgical treatment of insulinoma:a report of 49 cases

Objective To evaluate the methods used for diagnosis and surgical treatment of insulinoma. Methods A total of 49 cases of insulinoma treated in our hospital in the past 20 years were reviewed. Results Of the 49 cases, 45 had typical Whipple's triad. The sensitivity of the disease was 47.3% (18/38) to ultrasonography, 60% (15/25) to CT, 64.7% (11/17) to MRI, 83.3% (5/6) to selective arteriography, 97.8% (44/45) to intraoperative palpation and 100% to intraoperative ultrasonography (12/12). Surgical enuleation was performed in 31 cases, resection of pancreatic tail in 4, resection of pancreatic body and tail in 7, Whipple in 1 and PPPD in 1. Conclusions Whipple's triad and IRI/G>0.3 can be used as parameters to diagnose insulinoma. Perioperative accurate localization of the tumors is difficult. Intraoperative ultrasonography and palpation is the best method for localizing diagnosis of the tumor. Enucleation is the best choice for treatment of benign insulinoma and can result in the lowest occurring rate of complications.