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目的回顾性分析88例胰岛素细胞瘤病例,探讨胰岛素细胞瘤的临床表现、诊断及治疗方法,总结出对于胰岛素细胞瘤的诊治经验。方法对笔者所在医院2003年10月至2010年1月期间收治的88例胰岛素细胞瘤患者的临床资料进行回顾性分析。结果 88例病例中女性患者占71.6%(63/88),年龄(38.59±11.95)岁,体质量指数为27.78±5.86,肿瘤直径为(1.62±0.70)cm,其中12例为多发性。Whipple三联征及空腹胰岛素/葡萄糖比值对胰岛素细胞瘤定性诊断的敏感度分别为86.4%(76/88)和79.5%(70/88)。腹部超声、CT、MRI及术中超声检查对胰岛素细胞瘤定位诊断的敏感度分别为30.8%(24/78)、74.6%(53/71)、82.5%(47/57)和100%(59/59)。88例患者中,仅行肿瘤剜除术60例,仅行胰腺远端切除术24例,同时行肿瘤剜除术及胰腺远端切除术4例。行肿瘤剜除术及胰腺远端切除术后胰瘘发生率分别为37.5%(24/64)和14.3%(4/28),总住院时间和术后住院时间分别为28 d及16 d和29 d及13 d,其差异均无统计学意义(P>0.05)。结论对胰岛素细胞瘤可根据Whipple三联征以及空腹胰岛素/葡萄糖比值获定性诊断,定位诊断可依靠术中超声。禁食试验可缩减至15 h。肿瘤剜除术与胰腺远端切除术的治疗效果及并发症发生率无明显差异。
Objective To retrospectively analyze 88 cases of insulinoma, investigate the clinical manifestations, diagnosis and treatment of insulinoma and summarize the experience of diagnosis and treatment of insulinoma. Methods The clinical data of 88 patients with insulinoma treated in our hospital from October 2003 to January 2010 were analyzed retrospectively. Results Among the 88 cases, 71.6% (63/88) were female patients, with a mean age of (38.59 ± 11.95) years, a body mass index of 27.78 ± 5.86, and a tumor diameter of (1.62 ± 0.70) cm, of which 12 were multiple. Whipple triad and fasting insulin / glucose ratio for the qualitative diagnosis of insulinoma were 86.4% (76/88) and 79.5% (70/88), respectively. The sensitivity of abdominal ultrasound, CT, MRI and intraoperative ultrasound in the diagnosis of insulinoma were 30.8% (24/78), 74.6% (53/71), 82.5% (47/57) and 100% (59) / 59). Among the 88 patients, only 60 cases were treated with tumor resection, and only 24 cases were treated with distal pancreatic resection. Tumor resection and distal pancreatectomy were performed simultaneously in 4 cases. The incidences of pancreatic fistula after tumor excision and distal pancreatectomy were 37.5% (24/64) and 14.3% (4/28), respectively. The total hospital stay and postoperative hospital stay were 28 days and 16 days, respectively 29 d and 13 d, the difference was not statistically significant (P> 0.05). Conclusion Insulinoma can be diagnosed according to the Whipple triad as well as the fasting insulin / glucose ratio. Positioning diagnosis can rely on intraoperative ultrasound. Fasting test can be reduced to 15 h. There was no significant difference in the therapeutic effect and incidence of complications between tumor resection and distal pancreatectomy.