摘要
目的总结胰岛素瘤的诊断和治疗经验。方法回顾性分析北京协和医院1953-2007年诊治404例胰岛素瘤的临床资料。结果肿瘤直径<2cm者占79.6%。36.2%的肿瘤位于胰头部,28.2%位于胰体部,35.6%位于胰尾部。18例(4.5%)为恶性胰岛素瘤,34例(9.0%)为多发性肿瘤。96.0%有典型的Whipple三联征。89.6%血胰岛素/血糖比值>0.3。术前定位检查发现胰岛素瘤敏感性:经腹超声检查36.8%,普通平扫CT24.7%,增强CT66.7%,多排螺旋CT胰腺灌注92.7%,MRI31.6%,生长抑素受体显像33.3%,超声内镜(EUS)79.1%,选择性动脉造影(SAG)84.6%,经皮经肝门静脉置管取血(PTPC)测定胰岛素88.1%,动脉刺激静脉取血(ASVS)测定胰岛素87.0%。术中定位诊断方法的敏感性:细针穿刺活检89.2%,术中超声(包括腹腔镜超声)检查90.0%。73.1%的病例可行肿瘤的局部摘除术。结论多排螺旋CT胰腺灌注是目前胰岛素瘤术前定位诊断的首选方法。随着微创外科技术在胰腺外科中的应用,对部分条件适宜的病例可选用腹腔镜手术,但对多发胰岛素瘤仍应仔细开腹探查,避免遗漏病灶。
Objective To summarize the experience in the diagnosis and treatment of insulinoma. Methods The clinical materials of 404 cases of insulinoma treated in Peking Union Medical College Hospital between 1953 and 2007 were analysed retrospectively. Results The diameter of 79.6% tumors was less than 2cm. 36.2% tumors were located in the head of the pancreas,28. 2% in the body,35.6% in the tail. 18 cases （4. 5% ） had malignant tumors. 34 cases （9.0%） were with multiple insulinomas. 96. 0% patients had Whipple＇ s triad and the ratio of insulin to glucose was greater than 0. 3 in 89. 6% patients. The positive rates of adjuvant examinations for localization before operation were transabdominal Ultrasound 36. 8% ,CT 24.7% ,Enhanced CT 66.7%, Muhislice spiral CT pancreatic perfusion 92. 7%, MRI 31.6%, Sematostatin receptor scintigraphy 33.3 %, Endoscopic Ultrasound 79. 1%, Selective Angiography 84. 6%, PTPC 88. 1% and ASVS 87.0% respectively. The positive rates of Fine needle aspiration biopsy and intraoperative Ultrasound were 89.2%, and 90. 0% respectively. 73.1% patients could be cured by enucleation of tumor. Conclusion Multislice spiral CT pancreatic perfusion came to be the preferred preoperative examination for localization of insulinoma. With the mini- mally invasive techniques further applied in pancreatic surgery, laparoscopic operation are suitable for some cases of insulinoma. In order to prevent missing tumors,however,open abdominal operation is adviced for the multiple insulinomas so as to explore more carefully.
出处
《中国实用外科杂志》
CSCD
北大核心
2008年第5期357-359,共3页
Chinese Journal of Practical Surgery
关键词
胰腺
胰岛素瘤
pancreas
insulinoma
