胰岛素瘤的外科治疗(附42例临床资料分析)  

Surgical treatment of the insulinoma

作　　者：吴树强[1] 李玉珠[1] 陈丽莉[1] 华鲁纯[1] 

机构地区：[1]上海医科大学华山医院外科教研室,200040

出　　处：《上海医学》1997年第8期451-453,共3页Shanghai Medical Journal

摘　　要：胰岛素瘤的定位及其多发性、异位性、隐匿性肿瘤的发现是外科治疗的难题。为提高手术成功率，减少复发率，对近24年来华山医院外科治疗的42例胰岛细胞瘤进行临床分析。结果表明，胰岛素瘤是胰岛细胞瘤中最常见者，胰岛素瘤的诊断不难，多有典型的Whipple三联症表现，但术前定位不易，主要依靠B超、选择性动脉造影和CT检查，术后复发率较高（23．8％），主要原因为肿瘤残留。7例术后复发再次手术，其中5例探查发现胰岛素瘤，切除肿瘤后治愈。术前不必过多致力于定位诊断，术中充分显露胰腺，过细的触摸胰腺各个区域是发现肿瘤的主要手段。如不能发现肿瘤，力争做术中B超，术中门静脉置管，分段取血测定胰岛素峰值位置，可指导手术，减少盲目性胰体尾切除。肿瘤完全切除是治疗成功的关键。The authors summarized the clinical experience of srugical treatment of 42 insulinoma in the past 24years at Hua Shan Hospital. The clinical materials showed that insulinoma is the commonest of the pancreatic islet cell tumors. With typical Whipple's triad, the diagnosis is usually not difficult, but it is difficult for preoperative localization that is mainly depended on transabdominal ultrasound examination, selective arteriography and CT scan. The recurrence rate was 23, 8% in this group, which was mainly as a result of tumor residue. Seven cases in this group tecruued after operation, and five cases were cured by totally resecting the tumor during the second operation. We consider that overmuch localization before operation is unnecessary, but sufficient exposure of pancreas and thorough palpating is essential to discover tumor. If the tumor cannot be discovered, intraoperative ultrasound examination or catheterization of portal vein to determine the location of the peak value of insulin is directive for operarion and avcid cut the pancreas blindly.Total removal of the tumor is the key of successful treatment.

关 键 词：胰岛素瘤 外科手术 

分 类 号：R736.705[医药卫生—肿瘤]