18 例胰岛素瘤的诊疗分析及文献复习

目的 分析胰岛素瘤的临床表现特点， 探讨胰岛素瘤的诊断和治疗方法。方法 回顾性分析 2008 年 1 月—2015 年 12 月我院收治的 18 例胰岛素瘤患者的临床资料， 并结合国内外相关文献进行诊治分析和总结。结 果 18 例患者均有典型 Wipple 三联征表现， 低血糖症状中以意识障碍发生率最高（15/18）。18 例中 5 例曾被误 诊。14 例患者行糖耐量-胰岛素释放试验， 其中 12 例在试验中出现低血糖值， 胰岛素/血糖值＞0.4 的患者至 3 h 时 有 8 例， 至 5 h 时有 12 例。各种影像学检查阳性比例分别为 B 超 6/15、 CT 平扫 1/6、 增强 CT 11/13、 灌注 CT 2/3、 核 磁平扫 10/12、 增强核磁 5/5、 超声内镜 1/1、 数字减影血管造影 （DSA） 1/2、 术中超声 2/2。18 例患者均行手术治疗， 术 后患者均未再有低血糖发作。结论 胰岛素瘤引起的低血糖症状中以意识障碍发生率最高。行 5 h 糖耐量-胰岛素 释放试验比行 3 h 更有意义。可采用多种检查方式联合使用进行肿瘤定位。手术治疗仍是胰岛素瘤患者的首选治 疗方法。

Clinical analysis of 18 cases of insulinoma and review of literature

Objective To analyze the clinical characteristics of insulinoma and evaluate the methods used in the diagnosis and treatment of insulinoma. Methods The clinical data of 18 patients with insulinoma were retrospectively analyzed from January 2008 to December 2015, which were combined with the domestic and foreign related literature for analysis and summary of diagnosis and treatment. Results All the 18 cases had Whipple triad syndrome. Unconsciousness was the most common syndrome due to hypoglycemia (15/18). Five of the patients were misdiagnosed. Fourteen cases had glucose tolerance- insulin release test, and 12 of them had hypoglycemia (blood glucose was below 2.78 mmol/L). Eight patients had a insulin/glucose ratio ＞0.4 in three hours, and 12 patients in 5 hours. Tumor was detected by several imaging techniques in different patients. The sensitivity rate for B ultrasound was 6/15, for plain CT was 1/6, for contract CT was 11/ 13, for perfusion CT was 2/3, for MRI was 10/12, for contract MRI was 5/5, for endoscopic ultrasonography was 1/1, for digital subtraction angiography (DSA) was 1/2, and for intraoperative ultrasonography (IOUS) was 2/2. All 18 patients were underwent surgical treatment, and no any patient was found episodes of hypoglycemia after surgery. Conclusion Consciousness is the most common symptom caused by insulinoma. The 5 h glucose-insulin release test is more meaningful than the 3 h test. Multiple inspection methods can be used for the clear localization of the tumors before operation. Surgery is still the most preferred treatment for insulinoma.