楊维良(胰岛素瘤例的诊断与外科治疗).docVIP

PAGE \* MERGEFORMAT 5 ·大会交流· 胰岛素瘤64例的诊断与外科治疗 杨维良 张好刚 张浩民 王惠良 迟强 王夫景 150086，哈尔滨医科大学附属第二医院普外科（杨维良、张好刚、迟强、王夫景）； 161000，齐齐哈尔医学院普外科（张浩民）； 157400，牡丹江市第二医院普外科（王惠良） 【摘要】目的 总结胰岛素瘤的诊断与外科治疗方法。方法 回顾性分析64例胰岛素瘤的临床资料。结果 64例均表现Whipple三联征。术前BUS、CT及强化CT、MRI、DSA诊断阳性率分别为46.9%（30/64），58.2%（23/39），66.7%（18/27），91.7%（11/12）。IOUS诊断阳性率为92%（23/25）。单个肿瘤58例，多发肿瘤6例。单发者位于胰头19例，其中直径4cm 1例，胰体17例，胰尾22例；多发者6例均为2枚肿瘤，4例位于胰体，2例分别位于胰体和胰尾各1枚。治疗 行肿瘤局部切除39例，胰体尾切除13例加作脾切除6例，胰尾切除8例加作脾切除4例，胰体表面肿瘤直径2cm行腹腔镜下单纯肿瘤摘除1例，自左向右分段切除（盲切法）2例，行胰头十二指肠切除1例。良性肿瘤62例，恶性2例。术后胰瘘3例、急性胰腺炎4例均经非手术治愈。64例术后低血糖症状消失。62例良性胰岛素瘤术后随诊1～5年血糖正常，其中2例分别于术后4年和5年复发，再次手术发现胰尾近脾门处分别有直径1cm和1.5cm肿瘤，经胰尾切除后治愈。45例随访8年血糖正常，17例失访。2例恶性胰岛素瘤分别于术后3年和4年复发，因肝转移死亡。结论 Whipple三联征和测定IRI/G＞0.3是定性诊断的依据。术中触诊联合IOUS是最有效的肿瘤定位诊断方法。胰岛素瘤切除术是最佳的治疗方法。 【关键词】 胰岛素瘤；诊断；治疗 【中图法分类号】R736.7 【文献标识码】B Diagnosis and Surgical Treatment of insulinoma in 64 Patients YANG Wei-liang*, ZHANG Hao-gang, ZHANG Hao-min, WANG Hui-liang，CHI Qiang，WANG Fu-jing. *Department of General Surgery, Second Affiliated Hospital of Harbin Medical University，Harbin 150086,China 【Abstract】Objective To summarize diagnosis and surgical treatment of insulinoma. Methods Clinical data of 64 patients with insulinoma from 1980 to 2006 were analyzed retrospectively. Results All patients had Whipple’s triad. Accurate preoperative localization rate of B ultrasonography, CT and Enhanced CT, MRI, DSA was 46.9% (30/64), 58.2 %(23/39) and 91.7%(11/12), respectively. Localization rate of intraoperative ultrasonography (IOUS) was 92% (23/25). The tumors were single in 58 cases, and multiple in 6 cases. In the location of single tumor, 19 of them were in the head, 17 in the body, and 22 in the tail; while for multiple tumors, 2 tumors were both located in the body in 4 patient, and 2 tumors were separately located in the body and tail respectively in 2 patients. Treatment Local enucleation was performed in 39 cases, resection of pancreatic body and tail in