Pancreatic insulinomas: diagnosis and surgical treatment of 74 patients

摘要

Objective: To summarize retrospectively the experi-ence in diagnosis and surgical treatment of pancreaticinsulinoma.Method: 74 patients who had been operated on andconfirmed pathologically from July 1967 to July 2001were enrolled. They were 37 men and 37 women,aged 41.91 years on average.Results: In all patients with typical Whipple’s triad,the ratio of insulin to glucose was measured over 0.3for at least one time. 52.70 % of the patients wereonce misdiagnosed, and only 20.27 % of them werecorrectly diagnosed in a year after onset of symp-toms. Their average course of the disease was 3.36years. B-ultrasonography and endoscopic ultrasonog-raphy (EUS) showed a low positive rate for localiza-tion of insulinoma. CT and magnetic resonance ima-ging (MRI) could correctly detected 63.41% and63.64 % of tumors respectively, in sharp contrast toa localization rate of 90 % for arterial stimulation andvenous sampling (ASVS). Single insulinoma was ob-served in 66 patients (89.19 %), multiple insulinomain 2 (2.70 %), hyperplasia in 4 (5.41%), and malig-nant insulinoma in 2 (2. 70%). Most (85. 29%) ofthe benign insnlinomas were less than 2 cm in diame-ter. Simple enucleation was the major operative pro-cedure for benign tumors. In 88. 52% of the pa-tients, glycemia increased to normal in 30 minutesafter tumor excision, and in the remaining patientswithin 2 hours. 97. 26% of the patients experiencedtemporary hyperglycemia but recovered in a week.The major complications of insnlinoma included pan-creatic fistulae (27.27 %) and pancreatitis (5. 19 %).Conclusions: Better recognization of insulinoma andits rational examination are essential to early diagno-sis. CT can be first used for localization, otherwiseASVS is used. Surgery is the major choice for thetreatment of insulinoma, but cautions should betaken to pancreatic fistulae after operation.