摘要
目的 探讨避免胰岛素瘤误诊 ,总结诊疗体会。方法 回顾性分析 1984～ 2 0 0 3年 12月收治的 17例胰岛素瘤的临床资料。结果 本组患者从发病到确诊 1～ 10年 ,平均 2 .5 4年 ,一年内确诊着 3例。占 17.6 4 % ,均有被误诊病史 ,最常见的误诊原因分别是反应性低血糖 (占 4 7.0 5 % )、癫痫、颅内病变。 5 2 .94 % (9/ 17)在确诊时有智力减退或反应迟钝 ,Whipple三联征 [胰岛素与血糖比值(I/G) >0 .3]。CT、MRI、术前B超、术中B超 (IOUS)诊断 ,均行手术治疗。其中肿瘤剜除术 9例 ,胰体尾切除 5例 ,楔形切除 3例 ,全组无手术死亡 ,术后无低血糖发作。术后胰瘘 2例。结论 Whipple三联征I/G >0 .3是胰岛素瘤定性诊断的主要依据。术前MRI、B超 ,术中详尽扪诊联合IOUS可取得较为满意的定位诊断 ,据胰岛素瘤大小、部位、数目采取适宜的手术方式是良好疗效的关键。
Objective To avoid misdiagnosis of insulinoma and summarize the diagnosis and treatment of experience. Methods The clinical materials of 17 patients with insulinoma treated in our hospital form January 1984 to December 2003 were retrospectively analyzed. Results In this group, the time needed for definite diagnosis ranged form 1 to 10 years, with a mean of 2.54 years. only 17.64% (3/17) patients got definite diagnosis with in one year. All patients had a history of misdiagnosis, including functional hypoglycemia, epilepsy, intracranail disease. meanwhile, 58.82% patients had intelligence retardation and reaction bluntness at the time when their conditions were confirmed as insulinoma. With computed tomography (CT) magnetic resonance imaging (MRI) preoperative ultrasonography (US) and intraoperative ultrasonography (IOUS) underwent radical resection, including enucleation of tumor in 9 cases. resection of distal pancreas in 5 cases. And wedge resection in 3 case. All cases of insulinomas were cured after resection. and 2cases were complicatdal with pancreatic fistulae. Conclusions Whipple triad and the ratio of insulin to glucose (>0.3) are the key ponts of diagnosos of insulinoma. The topographic diagnosis by a combination of preoperative MRI, US. In preoperative palpation and IOUS for insulinoma is essential for selection of surgical treatment modalities and successful therapeutic efficacy.
出处
《消化外科》
CSCD
2004年第5期336-337,共2页
Journal of Digestive Surgery
关键词
胰岛细胞瘤
误诊
超声诊断
治疗
insulinoma misdiagnosisi ultrasonography treatment
