18例胰岛细胞瘤的临床特点及诊治体会

发布时间：2019-01-06 05:05

【摘要】：目的探讨胰岛细胞瘤的临床特点、诊治方法及转归。方法回顾性分析2000年1月—2013年4月北京大学第一医院收治的18例胰岛细胞瘤患者的临床特点、诊断和治疗方法、转归等资料。结果 18例患者中,男女比为1∶2;年龄为18~83岁,中位年龄51岁。16例为功能性胰岛细胞瘤,2例为无功能性胰岛细胞瘤,功能性胰岛细胞瘤均为胰岛素瘤,其中2例合并糖尿病。胰岛素瘤患者临床上均有典型的Whipple三联征;血糖为0.85~2.56mmol/L,同时胰岛素水平10 m U/L有16例,胰岛素释放指数0.4有11例,胰岛素释放修正指数100有14例。胰岛素瘤患者行B超检查11例,5例阳性;行增强CT检查14例,11例阳性。行B超、CT检查均阴性的3例患者分别经胃镜超声、经皮经肝门静脉置管分段采血测定胰岛素(PTPC)、剖腹探查术中B超及分段采血方法进行诊断。17例胰岛细胞瘤患者行手术治疗,其中行肿瘤局部切除术10例,胰腺体尾部切除术6例,Whipple术式1例。患者术后均未出现严重并发症,胰岛素瘤患者术后低血糖均恢复。结论胰岛细胞瘤以功能性胰岛素瘤居多,少数合并糖尿病,确诊需有典型的Whipple三联征、胰岛素水平测定及胰岛素释放指数定性诊断,增强CT定位检查阳性率高。胰岛细胞瘤良性率高,治疗以外科手术为主。
[Abstract]:Objective to investigate the clinical features, diagnosis and treatment of islet cell tumor. Methods from January 2000 to April 2013, 18 cases of islet cell tumor treated in the first Hospital of Peking University were retrospectively analyzed. Results in 18 patients, the ratio of male to female was 1: 2; The median age was 51 years. 16 cases were functional islet cell tumor, 2 cases were nonfunctional islet cell tumor, 2 cases were insulinoma, 2 cases were complicated with diabetes. The typical Whipple triple sign was found in all patients with insulinoma, the blood glucose was 0.85 ~ 2.56 mmol / L, the insulin level was 10 m U / L in 16 cases, the insulin release index was 0.4 in 11 cases, and the insulin release correction index was 14 cases. 11 cases of insulinoma were examined by B-ultrasound, 5 cases were positive, and 14 cases were examined by enhanced CT, 11 cases were positive. Three patients who were negative for B-ultrasound and CT were examined by gastroscopy and percutaneous transhepatic portal vein catheterization for the determination of insulin (PTPC),. 17 cases of islet cell tumor were treated by operation, including 10 cases of tumor local resection, 6 cases of pancreatic body and tail resection and 1 case of Whipple operation. No serious complications occurred in all patients, and hypoglycemia recovered in all patients with insulinoma. Conclusion functional insulinoma is the most common type of islet cell tumor, a few of them are complicated with diabetes mellitus. The diagnosis of islet cell tumor requires typical Whipple triple sign, insulin level measurement and insulin release index qualitative diagnosis. The positive rate of enhanced CT localization examination is high. The benign rate of islet cell tumor is high and surgical treatment is the main treatment.
【作者单位】：北京大学第一医院内分泌科;
【分类号】：R736.7

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