胰岛素瘤35例诊断和治疗分析  

Diagnosis and treatment of 35 cases of insulinoma

作　　者：李腾宇[1] 许元鸿[1] 赵爽[2] 郭克建[1] 郭仁宣[1] 葛春林[1] 

机构地区：[1] 中国医科大学附属第一医院普通外科教研室胰腺外科,沈阳110001 [2] 中国医科大学附属第一医院肿瘤内科,沈阳110001

出　　处：《临床外科杂志》2015年第3期188-190,共3页Journal of Clinical Surgery

摘　　要：目的：提高胰岛素瘤的诊断和治疗水平。方法回顾性分析收治的35例胰岛素瘤患者的临床资料。35例患者中，男10例，女25例，97.1%（34/35）有典型的Whipple三联征。术前影像学检查有超声、增强CT、胰腺3D-CT、MRI、CT胰腺灌注扫描、EUS及术中超声（ IOUS），诊断阳性率分别为50.0%（15/30），77.8%（14/18），80.0%（8/10），93.8%（15/16），91.7%（11/12），100%（1/1），100%（3/3）。结果35例均行手术治疗。术后随访3∽113个月，平均50个月，2例失访，余33例未见复发。结论无创检查中，定位诊断首选胰腺CT灌注扫描。术中触诊联合超声定位，准确率接近100%。对于良性病变，胰岛素瘤摘除术是首选的治疗方式。对于恶性胰岛素瘤，可行胰腺部分切除术或胰十二指肠切除术。Objective To discusse the diagnosis and treatment of insulinoma. Methods The clinical data of insulinoma treated in the First Hospital of China Medical University between January 2005 and July 2014 were analyzed retrospectively. Among the 35 patients,there were 10 males and 25 females, and 97. 1%（34/35）had typical Whipples′triad. Preoperative localization accuracy of B-scan ultrasonogra-phy,enhanced CT,pancreatic 3D-CT,MRI,CT pancreatic perfusion,EUS,and IOUS was 50. 0%（15/30）, 77. 8%（14/18）,80. 0%（8/10）,93. 8%（15/16）,91. 7%（11/12）,100%（1/1）,and 100%（3/3）,re-spectively. Results All 35 patients underwent surgery. The patients had a mean follow-up of 50 months ranging from 3 to 113 months. Except for 2 lost cases,all had no recurrence of tumor. Conclusion CT pancreatic perfusion can be the first choice of non-invasive examination for diagnosing insulinoma. Intraop-erative palpation with ultrasound can increase the accuracy nearly to 100%. For benign insulinoma,insulin tumor excision is the preferred treatment. Partial pancreatic resection or pancreaticoduodenectomy can be chosen for malignant insulinoma.

关 键 词：胰腺 胰岛素瘤 诊断 治疗 

分 类 号：R736.7[医药卫生—肿瘤]