胰岛素瘤的诊断与治疗（附38例临床分析）  

Diagnosis and treatment of insulinoma and clinical analysis of 38 cases

作　　者：张俊[1] 薛新波[1] 申铭[1] 姜立[1] 郑建伟[1] 陈堃[1] 于愿[1] 肖朝文[1] 李俊[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,武汉430030

出　　处：《临床外科杂志》2009年第6期384-386,共3页Journal of Clinical Surgery

摘　　要：目的总结胰岛素瘤的诊断和治疗经验。方法收集我院1988年10月至2008年10月收治的38例胰岛素瘤的临床资料，对其临床表现、诊断和治疗方法进行回顾性分析。结果全组38例患者均表现Whipple三联征。术前定位检查发现胰岛素瘤阳性率分别为：经腹超声78．95％，CT54．17％，MRI33．33％，EUS100．00％，DSA40．00％。术中B超联合扪诊检查阳性率90．00％。其中34例患者在我院接受手术治疗37次，包括胰岛素瘤局部摘除术28次，胰体尾（或胰尾）切除术5次，胰体尾（或胰尾）加脾切除3次。术后病理证实单发良性肿瘤32例，多发1例．有恶性倾向1例。肿瘤完全切除的患者术后低血糖症状消失。术后胰瘘5例，均经非手术治疗痊愈。结论Whipple三联征和反应性胰岛素／血糖〉0．3是定性诊断的主要依据，术前诊断阳性率较高的是EUS、经腹超声和CT，术中扪诊联合术中超声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。Objective To summarize the experience in the diagnosis and treatment of insulinoma. Methods The clinical data of 38 cases of insulinoma treated in our hospital from October 1988 to October 2008 were collected, and the clinical manifestations, diagnosis and treatment were retrospectively analyzed. Results All of the 38 cases had typical Whipple＇s triad. The positive rate of adjuvant examinations for localization before operation was 78.95% by transabdominal ultrasound, 54. 17% by CT, 33.33% by MRI,100.00% by EUS, and 40.00% by DSA, respectively. The positive rate of IOUS plus palpable consultation was 90.00%. Thirty - four patients received 37 operations in our hospital, including enucleation of insulinoma （28 times ）, the body and tail of pancreas （or pancreatic tail ） excision （5 times）, the body and tail of pancreas （or pancreatic tail） excision plus splenectomy （3 times）. Pathological examination after surgery confirmed that there were 33 cases of single benign insulinomas, 1 case of multiple insulinoma, and 1 case of malignant tendency. Hypoglycemia symptoms of the patients whose tumor was completely resected disappeared after operations. All of 5 cases of postoperative pancreatic fistula were cured by non - surgical treatment. Conclusion Whipple triad and the IRI/G 〉 0.3 are the main basis for the qualitative diagnosis. EUS, transabdominal ultrasonography and CT had a high positive rate of preoperative diagnosis. Intraoperative palpable examination in combination with intraoperative ultrasonography is the most effective tumor targeting means. Enucleation of insulinoma is the main surgical procedure.

关 键 词：胰岛素瘤 诊断 治疗 

分 类 号：R736.7[医药卫生—肿瘤]