Objective To study the diagnosis and treatment of insulinoma Methods The data of 19 inpatients from Jan. 2006 to Dec. 2011 diagnosed as insulinoma were retrospectively analyzed. Results All cases had typical Whipple's triad, low plasma glucose and high plasma insulin concentrations. The lowest plasma glucose recorded was 0. 3 rnmol/L, and the highest plasma insulin concentration was 257. 5 U/L. The positive rate of B-ultrasonography,CT and MRI was 47. 4 %,71. 4 % and 77. 8 % respectively. Positive results were not found in 3 cases by CT and MRI, and then were found in all 3 cases (100 %) by arterial stimulation procedure with venous sampling (ASVS). Operation was performed on 17 patients. Local tumor excision was performed on 6 patients, distal pancreatecto-my plus splenectomy on 6 patients, distal pancreatectomy on 3 patients, and pancreaticoduodenectomy on 2 patients. The plasma glucose levels in all patients were increased significantly after the resection of the tumor, then slowly turned down to normal range. During a follow-up period of one to five years, the plasma glucose levels in 17 patients remained steady and there was no hypoglycemia or recurrence or metastasis of the tumor. Conclusion Insulinoma is most convincingly qualitatively diagnosed by clinical feature and laboratory examination, and CT or MRI is the preferred approach for localization diagnosis. The ASVS achieves a distinct advantage in localization of insulinoma. The exclusive treatment is surgical excision.%目的 分析探讨胰岛素瘤的诊断和治疗.方法 回顾性分析2006年1月至2011年12月收治的胰岛素瘤19例.结果 所有病人均有典型的Whipple三联征.化验均显示血糖降低及胰岛素升高,血糖最低者为0.3 mmol/L,血清胰岛素最高达257.5 U/L.影像学检查:B超、CT、MRI检查的阳性率分别为47.4％、71.4％和77.8％.3例因CT及MRI无阳性发现而行选择性动脉钙刺激静脉采血(ASVS)测定胰岛素检查,阳性率达100％.17例接受手术治疗,其中局部切除6例,胰体尾联合脾脏切除6例,胰体尾切除3例,胰十二指肠切除2例.所有病例在肿瘤被切除后血糖均明显上升.随访1～5年,病人均血糖稳定,未发生低血糖症,也未见肿瘤复发和转移.结论 胰岛素瘤的定性诊断有赖于典型的临床表现和化验检查,定位诊断则依靠影像学检查,CT和MRI仍是首选,ASVS初步显示了在定位诊断中的优势.手术切除是该病唯一的治疗方法.
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