胰岛素瘤诊治经验（附61例临床分析）  

Diagnosis and treatment of insulinoma：clinical analysis of 61 cases

作　　者：高志强[1] 俞亚红[1] 申铭[1] 薛新波[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,武汉430030

出　　处：《临床外科杂志》2012年第2期97-98,共2页Journal of Clinical Surgery

摘　　要：目的 探讨胰岛素瘤的临床诊治经验.方法 回顾性分析我院1986年8月至2011年7月间61例胰岛素瘤患者的临床资料.结果 均表现典型Whipple三联征,血胰岛素/血糖（IRI/G）均＞0.3.术前腹部超声、CT、EUS、术中超声、MRI和DSA诊断的阳性率分别为77.4%、63.2%、72.7%、91.7%、46.2%、33.3%.行胰岛素瘤剜除术50例,行胰体尾切除术4例,行胰体尾联合脾切除术5例,行保留十二指肠的胰头切除术1例,行胰十二指肠切除术1例.术后病理均为良性胰岛素瘤,无恶性病例.结论 胰岛素瘤的定性诊断主要靠典型Whipple三联征与IRI/G〉0.3,术前定位诊断主要依靠EUS、腹部超声和CT,术中超声结合扪诊是最有效的定位方法.肿瘤剜除术是胰岛素瘤的主要术式.Objective To discuss the methods of diagnosis and surgical treatment of insulinoma. Methods Sixty-one cases of insulinoma treated in our hospital from August 1986 to July 2011 were retro- spectively analyzed. Results All of the 61 cases had typical Whippleg triad and the insulin/glucose ratio （IRI/G）was greater than 0.3. The diagnostic sensitivity of transabdominnal ultrasound was 77.4% , CT was 63.2% ,EUS was 72.7% ,IOUS was 91.7% ,MRI was 46.2% and DSA was 33.3%. We performed simple enucleation for 50 cases, resection of pancreatic body and tail for 4, resection of pancreatic body and tail plus the spleen for 5, central resection of pancreas for 1 and pancreaticoduodenectomy for 1. No case of malignant tumor was found after operation. Conclusion Whipple＇s triad and IRI/G 〉 0.3 is the main basis for the qualitative diagnosis of insulinoma. Localization of insulinoma before the operation mainly de- pends on EUS, transabdominnal ultrasound and CT. IOUS combined with intmoperative palpation is the most effective method for intraoperative localization of insulinoma. Simple enucleation is the most common surgical method.

关 键 词：胰岛素瘤 诊断 治疗 临床分析 

分 类 号：R657.5[医药卫生—外科学]