胰岛素瘤1例报告并国内文献复习
| 作者: |
1方孟园,
1刘莉,
1朱一维
1 遵义医学院附属医院 肝胆外科，贵州 遵义 563000 |
| 通讯: |
刘莉
Email: li88li@yeah.net |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2015.09.009 |
摘要
目的：探讨胰岛素瘤（胰腺β细胞瘤）诊断和治疗方法。
方法：报告收治的1例胰岛素瘤患者并结合国内文献报道的1 362例胰岛素瘤患者资料进行分析。
结果：1 363例患者中，1 286例（94.35%）有典型Whipple三联征表现；1 099例计算胰岛素释放指数（IRI/G）患者中，1 019例（92.72%）IRI/G>0.3。术前B超、CT、MRI、选择性动脉造影（DSA）、选择性动脉内葡萄糖酸钙激惹实验（ASVS）、超声内镜检查（EUS）、经皮经肝门静脉置管分段采血测定胰岛素（PTPC）、生长抑素受体显像（SRS）、术中超声（IOUS）联合扪诊的肿瘤检出情况分别为40.90%（418/1 022）、55.20%（457/823）、52.45%（96/183）、77.42%（247/319）、89.47%（34/38）、78.68%（48/61）、86.11%（62/70）、36.36%（8/22）、93.97%（312/332）。所有患者均行手术治疗，其中1 006例（73.80%）行肿瘤剔除。病理诊断均为胰岛素瘤；42例（3.08%）为恶性变；98例（7.19%）多发；28.25%的肿瘤位于胰头部，33.90%位于胰体部，37.83%位于胰尾部。276例（20.25%）发生胰瘘。术后良性肿瘤复发16例，恶性病变复发7例。
结论：Whipple三联征和IRI/G>0.3可作为胰岛素瘤定性诊断的主要依据。可联合多种方法进行术前定位，IOUS联合扪诊是简单有效的定位诊断方法。肿瘤的局部剜除术是多数胰岛素瘤的最主要的手术治疗方式。
关键词：
胰岛素瘤/诊断；胰岛素瘤/治疗；综述文献
方法：报告收治的1例胰岛素瘤患者并结合国内文献报道的1 362例胰岛素瘤患者资料进行分析。
结果：1 363例患者中，1 286例（94.35%）有典型Whipple三联征表现；1 099例计算胰岛素释放指数（IRI/G）患者中，1 019例（92.72%）IRI/G>0.3。术前B超、CT、MRI、选择性动脉造影（DSA）、选择性动脉内葡萄糖酸钙激惹实验（ASVS）、超声内镜检查（EUS）、经皮经肝门静脉置管分段采血测定胰岛素（PTPC）、生长抑素受体显像（SRS）、术中超声（IOUS）联合扪诊的肿瘤检出情况分别为40.90%（418/1 022）、55.20%（457/823）、52.45%（96/183）、77.42%（247/319）、89.47%（34/38）、78.68%（48/61）、86.11%（62/70）、36.36%（8/22）、93.97%（312/332）。所有患者均行手术治疗，其中1 006例（73.80%）行肿瘤剔除。病理诊断均为胰岛素瘤；42例（3.08%）为恶性变；98例（7.19%）多发；28.25%的肿瘤位于胰头部，33.90%位于胰体部，37.83%位于胰尾部。276例（20.25%）发生胰瘘。术后良性肿瘤复发16例，恶性病变复发7例。
结论：Whipple三联征和IRI/G>0.3可作为胰岛素瘤定性诊断的主要依据。可联合多种方法进行术前定位，IOUS联合扪诊是简单有效的定位诊断方法。肿瘤的局部剜除术是多数胰岛素瘤的最主要的手术治疗方式。
Insulinoma: a report of one case and domestic literature review
CorrespondingAuthor:LIU Li Email: li88li@yeah.net
Abstract
Objective: To investigate the diagnosis and treatment of insulinoma (pancreatic β-cell tumor).
Methods: We admitted and treated one case of insulinoma, and that case together with the data of 1 362 patients with insulinoma documented in the literature in China were analyzed.
Results: Of the 1 363 patients, 1 286 cases (94.35%) showed signs of Whipple’s triad, and the insulin to glucose ratio (IRI/G) was calculated in 1 099 patients, which in 1 019 cases (92.72%) was higher than 0.3. The preoperative tumor detection by B-type ultrasound scan, CT, MRI, selective angiography (DSA), selective arterial calcium stimulation (ASVS), Endoscopic ultrasonography (EUS), percutaneous transhepatic portal catheterization (PTPC), somatostatin receptor scintigraphy (SRS) and intraoperative ultrasound (IOUS) plus palpation was 40.90% (418/1 022), 55.20% (457/823), 52.45% (96/183), 77.42% (247/319), 89.47% (34/38), 78.68% (48/61), 86.11% (62/70), 36.36% (8/22), and 93.97% (312/332), respectively. All patients underwent surgery, and 1 006 cases (73.80%) received tumor enucleation. All of them were diagnosed as insulinoma by postoperative pathology, 42 cases (3.08%) had malignant change, 98 cases (7.19%) had multiple lesions, 28.25% tumors were located in the head of the pancreas, 33.90% in the body of the pancreas, and 37.83% in the tail of the pancreas. Pancreatic fistula occurred in 276 patients (20.25%). Recurrence occurred in 16 benign cases and in 7 malignant cases after operation.
Conclusion: Whipple’s triad and IRI/G higher than 0.3 can be used as the main evidence for diagnosis of insulinoma. Preoperative localization can be made by combination of different methods, and IOUS plus palpation is a simple and effective method for intraoperative localization. Enucleation is the major surgical treatment for insulinoma.
Keywords：
Methods: We admitted and treated one case of insulinoma, and that case together with the data of 1 362 patients with insulinoma documented in the literature in China were analyzed.
Results: Of the 1 363 patients, 1 286 cases (94.35%) showed signs of Whipple’s triad, and the insulin to glucose ratio (IRI/G) was calculated in 1 099 patients, which in 1 019 cases (92.72%) was higher than 0.3. The preoperative tumor detection by B-type ultrasound scan, CT, MRI, selective angiography (DSA), selective arterial calcium stimulation (ASVS), Endoscopic ultrasonography (EUS), percutaneous transhepatic portal catheterization (PTPC), somatostatin receptor scintigraphy (SRS) and intraoperative ultrasound (IOUS) plus palpation was 40.90% (418/1 022), 55.20% (457/823), 52.45% (96/183), 77.42% (247/319), 89.47% (34/38), 78.68% (48/61), 86.11% (62/70), 36.36% (8/22), and 93.97% (312/332), respectively. All patients underwent surgery, and 1 006 cases (73.80%) received tumor enucleation. All of them were diagnosed as insulinoma by postoperative pathology, 42 cases (3.08%) had malignant change, 98 cases (7.19%) had multiple lesions, 28.25% tumors were located in the head of the pancreas, 33.90% in the body of the pancreas, and 37.83% in the tail of the pancreas. Pancreatic fistula occurred in 276 patients (20.25%). Recurrence occurred in 16 benign cases and in 7 malignant cases after operation.
Conclusion: Whipple’s triad and IRI/G higher than 0.3 can be used as the main evidence for diagnosis of insulinoma. Preoperative localization can be made by combination of different methods, and IOUS plus palpation is a simple and effective method for intraoperative localization. Enucleation is the major surgical treatment for insulinoma.