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目的 分析胰岛素瘤误诊原因,探讨避免误诊、误治的策略。方法 对1990年1月至2001年9月北京协和医院收治的71例胰岛素瘤患者的临床资料进行回顾性分析。结果 本组患者从发病到确诊时间为3个月～30年,平均4.24年,1年内获得确诊者17例,占23.9％。93％的患者有被误诊的病史,最常见的误诊原因分别为反应性低血糖（38％）、癫痫（23.9％）、颅内病变（21.1％）和脑血管病（12.6％）;4.2％的患者被误诊为精神病。在获得确诊时,54.9％的患者有不同程度的记忆力下降,智力减退或反应迟钝。结论 Whipple三联征和胰岛素/血糖（I/G）>0.3是胰岛素瘤定性诊断的主要依据。提高对胰岛素瘤的警惕性,合理应用辅助检查,有助于减少误诊。对定性诊断明确的患者,无论能否获得定位诊断,均应及早手术探查,以免延误治疗。
Objective To analyze the causes of misdiagnosis of insulinoma and to explore strategies to avoid misdiagnosis and misdiagnosis. Methods The clinical data of 71 patients with insulinoma admitted to Peking Union Medical College Hospital from January 1990 to September 2001 were analyzed retrospectively. Results The patients from the onset to the diagnosis of time for 3 months to 30 years, an average of 4.24 years, 17 cases were confirmed within 1 year, accounting for 23.9%. 93% of the patients had a history of being misdiagnosed. The most common causes of misdiagnosis were reactive hypoglycemia (38%), epilepsy (23.9%), intracranial lesions (21.1%) and cerebrovascular disease (12.6% Of patients were misdiagnosed as mentally ill. At the time of diagnosis, 54.9% of patients had varying degrees of memory loss, mental retardation or unresponsiveness. Conclusion Whipple triad and insulin / blood glucose (I / G)> 0.3 is the main basis for the qualitative diagnosis of insulinoma. Improve the vigilance of insulinoma, the rational use of auxiliary examination, help to reduce misdiagnosis. Qualitative diagnosis of patients with clear, regardless of access to positioning diagnosis, surgery should be as early as possible to avoid delay treatment.