【摘要】 目的:探讨胰岛素瘤的诊断和外科治疗方法。方法:回顾性分析我院31年余诊治的72例胰岛素瘤的临床资料。结果:84.72%有典型的Whipple三联征表现。80.56%血浆免疫反应性胰岛素/血糖(IRI/G)比值>0.3。术前定位诊断方法的阳性率分别为:腹部超声78.13%,CT(平扫或增强)60.97%,多排螺旋CT胰腺灌注100%,MRI 37.50%,内镜超声(EUS)72.73%,选择性动脉造影(DSA)28.57%。术中超声联合扪诊诊断阳性率92.31%。肿瘤最大直径≤2 cm者占88.75%。37.5%的肿瘤位于胰头颈部,27.50%位于胰体部,35.0%位于胰尾部。81.58%的病例可行胰岛素瘤局部剜除术。病理诊断均为胰岛素瘤,65例(90.28%)为功能性胰岛素瘤,7例(9.72%))为无功能性胰岛素瘤;4例(5.56%)为多发性肿瘤,2例(2.78%)恶性倾向,1例(1.39%)合并多发性内分泌肿瘤1型(MEN-1)。结论:Whipple三联征和IRI/G>0.3可作为胰岛素瘤定性诊断的主要依据。应联合应用超声,CT,多排螺旋CT胰腺灌注,MRI,内镜超声和DSA多种方法进行术前定位。术中超声联合扪诊是简单有效的定位诊断方法。肿瘤的局部剜除术是多数胰岛素瘤的最佳手术治疗方式。更多还原

【Abstract】 Objective: To investigate the diagnosis and surgical treatment of insulinoma. Methods: The clinical data of 72 patients with insulinoma admitted to our hospital spanning more than 31 years were retrospectively analyzed. Results: Of the 72 patients,84.72% had a typical Whipple’s triad,and the ratio of plasma immunoreactive insulin to glucose(IRI/G) was greater than 0.3 in 80.56%.The positive rates of preoperative niveau diagnosis were 78.13% by transabdominal ultrasonography,60.97% by CT,100% by pancreatic perfusion imaging of multislice spiral CT,37.50% by MRI,72.73% by endoscopic ultrasound and 28.57% by DSA,respectively.The diagnostic positive detection rate of intraoperative ultrasonography(IOUS) plus palpation was 92.31%.The diameters of 88.75% of the tumors were less than 2 cm,and 37.5% of tumors were located in the head and neck of the pancreas,27.5% in the body,and 35.0% in the tail,and 81.58% of the patients had indications for regional enucleation of insulinoma.All of the 72 cases were confirmed as insulinoma by final pathology,of whom 65(90.28%) were functional insulinoma,7(9.72%) were nonfunctional insulinoma,4(5.56%) were multiple insulinoma,2(2.78%) had malignant tendency,and 1(1.39%) was combined with multiple endocrine neoplasia type 1(MEN-1). Conclusion: Whipple’s triad and IRI/G>0.3 can be the main basis for the defining diagnosis of insulinoma.A combination of multiple examinations such as ultrasonography,CT,pancreatic perfusion imaging of multislice spiral CT,MRI,endoscopic ultrasound and DSA may be recommended before operation,and IOUS plus palpation is a simple and effective way for intraoperative localization.Regional enucleation of insulinoma is the best surgical approach for most insulinoma.更多还原