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目的分析胰岛素瘤的定性和定位诊断方法。方法回顾性分析我院2005年4月—2008年10月收治的4例胰岛素瘤患者的定性、定位诊断方法。结果定性诊断:4例患者均有Whipple三联征,饥饿试验阳性,胰岛素/血糖均>0.3。定位诊断:腹部B超检查1例胰头部有低回声灶;普通CT(层厚5.0mm)平扫均为阴性,选择性动脉钙刺激静脉采血(ASVS)测定胰岛素水平试验均能明确肿瘤部位;CT薄扫+增强扫描显示均有阳性发现;3例行术中B超检查,均发现低回声灶。3例患者行手术治疗,术中B超定位均与ASVS定位及CT薄扫+增强扫描结果相符,病理均证实为胰岛素瘤。结论胰岛素瘤的定性诊断目前仍然依靠Whipple三联征、低血糖及高血浆胰岛素;在定位诊断中,ASVS定位可以明确肿瘤分布部位,联合CT薄扫+增强扫描可提高术前定位率。
Objective To analyze the qualitative and localization of insulinoma. Methods A retrospective analysis of our hospital from April 2005 -2008 in October admitted 4 cases of insulinoma patients with qualitative diagnosis method. Results Qualitative diagnosis: Whipple triad in 4 patients, positive hunger test, insulin / blood glucose> 0.3. Positioning diagnosis: one case of abdominal B-ultrasound examination of the pancreas had hypoechoic lesions; plain CT (thickness 5.0mm) plain scan were negative, selective arterial calcium-stimulated venous blood (ASVS) determination of insulin levels test can clear the tumor site ; CT thin scan + enhanced scan showed positive findings; 3 cases underwent B-ultrasound, were found in low echo lesions. Surgical treatment was performed in 3 patients. The intraoperative B-ultrasound localization was consistent with the results of ASVS and CT scan and enhanced scan. The pathology was confirmed as insulinoma. Conclusions The qualitative diagnosis of insulinoma still relies on Whipple triad, hypoglycemia and high plasma insulin. In the localization diagnosis, ASVS localization can confirm the distribution of the tumor. Combined with thin-slice CT and enhanced CT can improve the preoperative localization rate.