Pancreatic insulinomas: diagnosis and surgical treatment of 74 patients.
Pancreatic insulinomas: diagnosis and surgical treatment of 74 patients.
复制标题
胰腺胰岛素瘤：74 例患者的诊断和手术治疗。
DOI：
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发表时间：
2002
影响因子：
3.3
通讯作者：
Hong
中科院分区：
文献类型：
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作者：
Xi Chen;Wei;Wei;Hong
目的
回顾性总结胰腺胰岛素瘤的诊断和外科治疗经验。
方法
从1967年7月至2001年7月，共纳入74例经手术和病理证实的患者。男37例，女37例，平均年龄41.91岁。
结果
在所有典型的维普莱三联征患者中，胰岛素/葡萄糖比值至少有一次超过0.3。52.70%的患者曾被误诊，发病后1年内正确诊断者仅占20.27%。平均病程3.36年。B超和内镜超声（EUS）对胰岛素瘤定位阳性率低。CT和MRI对肿瘤的定位准确率分别为63.41%和63.64%，而动脉刺激和静脉取样（ASVS）的定位准确率为90%。单发胰岛素瘤66例（89.19%），多发胰岛素瘤2例（2.70%），增生4例（5.41%），恶性胰岛素瘤2例（2.70%）。良性胰岛素瘤直径多小于2cm（85.29%）。单纯眼球摘除术是良性肿瘤的主要手术方式。88.52%的患者在肿瘤切除后30分钟内恢复正常，其余患者在2小时内恢复正常。97.26%的患者出现一过性高血糖，但在1周内恢复。胰岛素瘤的主要并发症为胰瘘（27.27%）和胰腺炎（5.19%）。
结论
提高对胰岛素瘤的认识，合理的检查有助于早期诊断。CT可首先用于定位，否则使用ASVS。手术是治疗胰岛素瘤的主要方法，但术后并发胰瘘应谨慎。
OBJECTIVE
To summarize retrospectively the experience in diagnosis and surgical treatment of pancreatic insulinoma.
METHOD
74 patients who had been operated on and confirmed pathologically from July 1967 to July 2001 were enrolled. They were 37 men and 37 women, aged 41.91 years on average.
RESULTS
In all patients with typical Whipple's triad, the ratio of insulin to glucose was measured over 0.3 for at least one time. 52.70% of the patients were once misdiagnosed, and only 20.27% of them were correctly diagnosed in a year after onset of symptoms. Their average course of the disease was 3.36 years. B-ultrasonography and endoscopic ultrasonography (EUS) showed a low positive rate for localization of insulinoma. CT and magnetic resonance imaging (MRI) could correctly detected 63.41% and 63.64% of tumors respectively, in sharp contrast to a localization rate of 90% for arterial stimulation and venous sampling (ASVS). Single insulinoma was observed in 66 patients (89.19%), multiple insulinoma in 2 (2.70%), hyperplasia in 4 (5.41%), and malignant insulinoma in 2 (2.70%). Most (85.29%) of the benign insulinomas were less than 2 cm in diameter. Simple enucleation was the major operative procedure for benign tumors. In 88.52% of the patients, glycemia increased to normal in 30 minutes after tumor excision, and in the remaining patients within 2 hours. 97.26% of the patients experienced temporary hyperglycemia but recovered in a week. The major complications of insulinoma included pancreatic fistulae (27.27%) and pancreatitis (5.19%).
CONCLUSIONS
Better recognization of insulinoma and its rational examination are essential to early diagnosis. CT can be first used for localization, otherwise ASVS is used. Surgery is the major choice for the treatment of insulinoma, but cautions should be taken to pancreatic fistulae after operation.