论文部分内容阅读
目的:探讨胰岛素瘤的诊断和治疗。方法:对2008年1月—2013年1月收治并手术的22例胰岛素瘤患者的临床资料进行回顾性分析。结果:良性胰岛素瘤21例(95.5%),恶性1例(4.5%);患者均有不同程度的Whipple三联征表现,4例有不同程度的精神神经症状;检测空腹血胰岛素15例,胰岛素释放指数均>0.3;术前B超,CT,MRI,生长抑素受体显像的肿瘤检出情况分别为22.7%(5/22),54.5%(12/22),53.8%(7/13),100%(1/1),术中B超检出率为100%(10/10)。行肿瘤摘除术18例,胰体尾切除2例,胰体尾+脾切除2例。术后21例患者血糖恢复正常,1例术后仍有持续的低血糖症状,3个月后行二次手术探查发现位于胰腺钩突一肿瘤,切除后血糖恢复正常;l例术后仍留有精神神经症状;发生胰瘘1例,经充分引流和抑制胰腺分泌治疗于3周后痊愈。结论:Whipple三联征和胰岛素释放指数>0.3是胰岛素瘤定性诊断的主要依据。术前CT和MRI等检查定位+手术探查、术中B超定位是有效的定位诊断方法。手术是治愈胰岛素瘤最重要的方法。
Objective: To investigate the diagnosis and treatment of insulinoma. Methods: The clinical data of 22 patients with insulinoma who were admitted to our hospital from January 2008 to January 2013 were analyzed retrospectively. Results: There were 21 cases (95.5%) of benign insulinomas and 1 case (4.5%) of malignant tumors. Whipple triad showed different degrees in all patients and neuropsychological symptoms in 4 cases. Fifteen cases of fasting insulin, (P <0.05). The detection rates of B ultrasound, CT, MRI and somatostatin receptor imaging before operation were 22.7% (5/22), 54.5% (12/22) and 53.8% ), 100% (1/1), and the rate of intraoperative B-ultrasound was 100% (10/10). Tumor excision in 18 cases, pancreatic body resection in 2 cases, pancreatic body tail + splenectomy in 2 cases. Blood sugar returned to normal after operation in 21 patients, and one patient had persistent hypoglycemia after operation. After three months of operation, he found a tumor located in the uncinate process of the pancreas and the blood glucose returned to normal after resection. One patient remained after operation Have neurological symptoms; occurred in 1 case of pancreatic fistula, after sufficient drainage and inhibition of pancreatic secretion in 3 weeks after treatment. Conclusion: Whipple triad and insulin release index> 0.3 are the main basis for the qualitative diagnosis of insulinoma. Preoperative CT and MRI inspection positioning + surgical exploration, intraoperative B-positioning is an effective method of positioning diagnosis. Surgery is the most important way to cure insulinoma.