【摘要】 目的:探讨胰岛素瘤(胰腺β细胞瘤)诊断和治疗方法。方法:报告收治的1例胰岛素瘤患者并结合国内文献报道的1 362例胰岛素瘤患者资料进行分析。结果:1 363例患者中,1 286例(94.35%)有典型Whipple三联征表现;1 099例计算胰岛素释放指数(IRI/G)患者中,1 019例(92.72%)IRI/G>0.3。术前B超、CT、MRI、选择性动脉造影(DSA)、选择性动脉内葡萄糖酸钙激惹实验(ASVS)、超声内镜检查(EUS)、经皮经肝门静脉置管分段采血测定胰岛素(PTPC)、生长抑素受体显像(SRS)、术中超声(IOUS)联合扪诊的肿瘤检出情况分别为40.90%(418/1 022)、55.20%(457/823)、52.45%(96/183)、77.42%(247/319)、89.47%(34/38)、78.68%(48/61)、86.11%(62/70)、36.36%(8/22)、93.97%(312/332)。所有患者均行手术治疗,其中1 006例(73.80%)行肿瘤剔除。病理诊断均为胰岛素瘤;42例(3.08%)为恶性变;98例(7.19%)多发;28.25%的肿瘤位于胰头部,33.90%位于胰体部,37.83%位于胰尾部。276例(20.25%)发生胰瘘。术后良性肿瘤复发16例,恶性病变复发7例。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。可联合多种方法进行术前定位,IOUS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主要的手术治疗方式。更多还原

【Abstract】 Objective: To investigate the diagnosis and treatment of insulinoma(pancreatic β-cell tumor).Methods: We admit ed and treated one case of insulinoma, and that case together with the data of 1 362 patients with insulinoma documented in the literature in China were analyzed.R esults: Of the 1 363 patients, 1 286 cases(94.35%) showed signs of W hipple’s tr iad, and the insulin to glucose ratio(IRI/G) was calculated in 1 099 patients, which in 1 019 cases(92.72%) was higher than 0.3. The preoperative tumor detection by B-ty pe ultrasound scan, CT, MRI, selective angiography(DSA), selective arterial calcium stimulation(ASVS), Endoscopic ultrasonography(EUS), percutaneous transhepatic portal catheterization(PTPC), somatostatin receptor scintigraphy(SR S) and intraoperative ultrasound(IOUS) plus palpation was 40.90%(418/1 022), 55.20%(457/823),52.45%(96/183), 77.42%(247/319), 89.47%(34/38), 78.68%(48/61), 86.11%(62/70), 36.36%(8/22), and 93.97%(312/332), respectively. All patients under went surger y, and 1 006 cases(73.80%) received tumor enucleation. All of them were diagnosed as insulinoma by postoperative patholog y, 42 cases(3.08%) had malignant change, 98 cases(7.19%) had multiple lesions, 28.25% tumors were located in the head of the pancreas, 33.90% in the body of the pancreas, and 37.83% in the tail of the pancreas. Pancreatic fistula occurred in 276 patients(20.25%). Recurrence occurred in 16 benign cases and in 7 malignant cases after operation.Conclusion: Whipple’s triad and IRI/G higher than 0.3 can be used as the main evidence for diagnosis of insulinoma. Preoperative localization can be made by combination of dif erent methods, and IOUS plus palpation is a simple and ef ective method for intraoperative localization. Enucleation is the major surgical treatment for insulinoma.更多还原