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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。
Objective: To investigate the diagnosis and treatment of insulinoma (pancreatic β-cell tumor). Methods: One case of insulinoma reported in our hospital and the data of 1 362 cases of insulinoma reported in our country were analyzed. Results: Of the 1 363 patients, 1 286 (94.35%) had typical Whipple triad manifestations. Among 1 099 patients with IRI / G, 1019 (92.72%) had IRI / G> 0.3. Preoperative ultrasonography, CT, MRI, selective arteriography (DSA), selective intra-arterial calcium glucagon challenge test (ASVS), endoscopic ultrasonography (EUS), percutaneous transhepatic portal vein catheterization The detection rates of PTPC, SRS, IOUS and palpation were 40.90% (418/1 022), 55.20% (457/823) and 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). All patients underwent surgical treatment, of which 1 006 cases (73.80%) were excluded from the tumor. Pathological diagnosis was insulinoma; 42 cases (3.08%) were malignant; 98 cases (7.19%) were multiple; 28.25% of the tumors were located in the head of pancreas, 33.90% in pancreatic body and 37.83% in pancreatic tail. Pancreatic fistula occurred in 276 cases (20.25%). 16 cases of benign tumor recurrence, 7 cases of recurrent malignant lesions. Conclusion: Whipple triad and IRI / G> 0.3 can be used as the main basis for the qualitative diagnosis of insulinoma. Can be combined with a variety of methods for preoperative positioning, IOUS joint palpation is a simple and effective method of positioning diagnosis. Local excision of the tumor is the most important surgical treatment of most insulinomas.