18例胰岛素瘤的诊疗分析及文献复习  

Clinical analysis of 18 cases of insulinoma and review of literature

作　　者：贾彦春[1] 何庆[1] 卫红艳[1] 袁梦华[1] 贾红蔚[1] 李凤翱[1] 崔景秋[1] 郑宝忠[1] 

机构地区：[1]天津医科大学总医院内分泌科,300050

出　　处：《天津医药》2016年第11期1301-1304,共4页Tianjin Medical Journal

摘　　要：目的分析胰岛素瘤的临床表现特点,探讨胰岛素瘤的诊断和治疗方法。方法回顾性分析2008年1月—2015年12月我院收治的18例胰岛素瘤患者的临床资料,并结合国内外相关文献进行诊治分析和总结。结果18例患者均有典型Wipple三联征表现,低血糖症状中以意识障碍发生率最高(15/18)。18例中5例曾被误诊。14例患者行糖耐量-胰岛素释放试验,其中12例在试验中出现低血糖值,胰岛素/血糖值>0.4的患者至3 h时有8例,至5 h时有12例。各种影像学检查阳性比例分别为B超6/15、CT平扫1/6、增强CT 11/13、灌注CT 2/3、核磁平扫10/12、增强核磁5/5、超声内镜1/1、数字减影血管造影(DSA)1/2、术中超声2/2。18例患者均行手术治疗,术后患者均未再有低血糖发作。结论胰岛素瘤引起的低血糖症状中以意识障碍发生率最高。行5 h糖耐量-胰岛素释放试验比行3 h更有意义。可采用多种检查方式联合使用进行肿瘤定位。手术治疗仍是胰岛素瘤患者的首选治疗方法。Objective To analyze the clinical characteristics of insulinoma and evaluate the methods used in thediagnosis and treatment of insulinoma. Methods The clinical data of 18 patients with insulinoma were retrospectivelyanalyzed from January 2008 to December 2015, which were combined with the domestic and foreign related literature foranalysis and summary of diagnosis and treatment. Results All the 18 cases had Whipple triad syndrome. Unconsciousnesswas the most common syndrome due to hypoglycemia(15/18). Five of the patients were misdiagnosed. Fourteen cases hadglucose tolerance- insulin release test, and 12 of them had hypoglycemia(blood glucose was below 2.78 mmol/L). Eightpatients had a insulin/glucose ratio >0.4 in three hours, and 12 patients in 5 hours. Tumor was detected by several imagingtechniques in different patients. The sensitivity rate for B ultrasound was 6/15, for plain CT was 1/6, for contract CT was 11/13, for perfusion CT was 2/3, for MRI was 10/12, for contract MRI was 5/5, for endoscopic ultrasonography was 1/1, fordigital subtraction angiography(DSA) was 1/2, and for intraoperative ultrasonography(IOUS) was 2/2. All 18 patients were underwent surgical treatment, and no any patient was found episodes of hypoglycemia after surgery. Conclusion Consciousness is the most common symptom caused by insulinoma. The 5 h glucose-insulin release test is more meaningful than the 3 h test. Multiple inspection methods can be used for the clear localization of the tumors before operation. Surgery is still the most preferred treatment for insulinoma.

关 键 词：胰岛素瘤 糖耐量试验 同步胰岛素释放试验 诊疗 

分 类 号：R587.3[医药卫生—内分泌]