胰岛素瘤的诊断与治疗  

Diagnosis and treatment of insulinoma

作　　者：何友钊[1,2] 翟年宽[1,2] 

机构地区：[1]南通大学第三附属医院 [2]无锡市第三人民医院外科,江苏无锡214000

出　　处：《肝胆胰外科杂志》2014年第1期1-4,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的 探讨胰岛素瘤的诊断治疗经验.方法 对本院2008年3月至2012年12月收治的10例胰岛素瘤资料进行回顾性研究.其中男2例,女8例;年龄11 ～ 52岁,平均（32±15）岁.通过对患者进行定性、定位检查确诊,并进行手术干预和随访观察.结果 7例为单纯性胰岛素瘤,3例为多发性内分泌肿瘤-1型（MEN-1）相关的胰岛素瘤;9例为良性肿瘤,1例为交界性肿瘤.10例均有典型的Whipp1e三联征.肿瘤直径＜2 cm者占79.5％.手术切除肿瘤16个,其中12.5％位于胰头部,6.25％位于胰颈部,25％位于胰体部,56.25％位于胰尾部.术前定位检查发现的胰岛素瘤敏感性：经腹超声检查30.5％,多排螺旋增强CT 68.9％,薄层CT灌注扫描79.5％.术中定位诊断方法的敏感性：术中多普勒超声检查100％.81.25％的病例可行肿瘤的局部摘除术.随访6个月～5年,10例病情稳定,血糖均在正常范围之内.结论 手术切除是胰岛素瘤的最佳治疗方式.薄层CT多期动态增强扫描是目前胰岛素瘤术前定位诊断的首选方法,术中多普勒超声显著提高手术切除率.加强对胰岛素瘤的认识,早期诊断并合理积极的手术治疗,能够改善患者生活质量.Objective To summarize the experience on diagnosis and treatment of insulinoma. Methods From Mar. 2008 to Jun. 2012, 10 patients of insulinoma were treated in our hospital. Of whom 2 patients were males and 8 females, aged from 11 to 52 years old, mean age （32 ± 15） years. They were definitely diagnosed by laboratory tests, imaging examinations, surgery and follow-up were perfomed on the patients. Results Ten patients were insulinomas, including 1 case of borderline tumor and 9 cases of benign insulinoma. All the 10 patients had typical Whipple＇s triad. The diameters of tumors less than 2 cm were 79.5%. Sixteen tumours were removed by sugery, tumors located in the head of the pancreas were 12.5%, in the neck 6.25%, in the body 25%, and in the tail 56.25%. The positive rates of adjuvant examinations for localization before operation were transabdominal ultrasound 30.5%, enhanced CT 68.9%, thin layer CT perfusion scanning 79.5%. The positive rates of intraoperative ultrasound were 96.5 %. 81.25% patients could be cured by enucleation of tumors. All the patients were followed up from 3 months to 6 years, and 10 patients with good conditions. Coneluslnn Surgical resection is the best treatment for insulinoma. Thin layer CT perfusion scanning is the preferred preoperativeexamination for localiza- tion of insulinoma. Doppler ultrasonic intraoperative can significantly increased the rate of excision. For well recognization and early diagnosis, appropriate surgical intervention will improve patients＇ life quality.

关 键 词：胰腺 胰岛素瘤 诊断 手术治疗 

分 类 号：R736.7[医药卫生—肿瘤]