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目的评估超声内镜(EUS)引导下无水乙醇注射法治疗良性胰岛素瘤的疗效与安全性,并与外科手术治疗法相比较。方法回顾性分析2011年4月-2016年2月在广西医科大学第一附属医院经EUS引导下无水乙醇注射法治疗或外科手术法治疗的38例良性胰岛素瘤临床资料。结果 97.4%(37/38)的患者有典型的Whipple三联征,82.9%(29/35)患者低血糖发作时胰岛素释放指数(I/G)>0.3。术前B超、CT、磁共振成像(MRI)、正电子发射计算机断层显像(PET/CT)和EUS定位诊断胰岛素瘤阳性率分别为50.0%、67.6%、66.7%、75.0%和89.7%。18例行EUS引导下无水乙醇注射治疗(EUS-FNI组),20例行外科手术治疗(外科手术组),EUS-FNI组术后均无并发症发生,外科手术组中40.0%(8/20)患者出现并发症。与外科手术组相比,EUS-FNI组在手术时间、术中出血、术后并发症、术后住院时间和住院总费用上均明显降低(P<0.05)。所有患者均得到随访,EUS-FNI组最后一次无水乙醇注射治疗后所有患者血糖平稳在正常范围;外科手术组20例患者中,90.0%(18/20)患者术后无低血糖症状再发作,监测血糖在正常范围,10.0%(2/20)患者术后低血糖症状发作较术前减少。结论 EUS引导下无水乙醇注射法治疗良性胰岛素瘤安全、有效。与外科手术法相比,具有微创、经济、并发症少和术后恢复快等优势。
Objective To evaluate the efficacy and safety of endoscopic ultrasonography (EUS) -based ethanol injection in the treatment of benign insulinoma and compare with surgical treatment. Methods The clinical data of 38 patients with benign insulinoma treated by absolute ethanol injection or surgical operation under the guidance of EUS at the First Affiliated Hospital of Guangxi Medical University from April 2011 to February 2016 were retrospectively analyzed. Results 97.4% (37/38) of patients had typical Whipple triad and 82.9% (29/35) patients had an insulin release index (I / G)> 0.3 at onset of hypoglycemia. The positive rates of preoperative diagnosis of insulinoma by B ultrasound, CT, MRI, PET / CT and EUS were 50.0%, 67.6%, 66.7%, 75.0% and 89.7%, respectively. . EUS-FNI group, EUS-FNI group, EUS-FNI group and EUS-FNI group. EUS-FNI group had no complications after surgery, / 20) Patients with complications. Compared with the surgical group, the EUS-FNI group was significantly lower in operation time, intraoperative bleeding, postoperative complications, postoperative hospital stay and hospitalization costs (P <0.05). All patients were followed up. All patients in the EUS-FNI group had stable blood glucose within the normal range after the last ethanol injection. Of the 20 patients in the surgical group, 90.0% (18/20) in the surgical group had no recurrence of hypoglycemia , Monitoring of blood glucose in the normal range, 10.0% (2/20) patients with postoperative hypoglycemic symptoms decreased compared with preoperative. Conclusion EUS-guided absolute ethanol injection in the treatment of benign insulinoma is safe and effective. Compared with the surgical method, with minimally invasive, economical, less complications and postoperative recovery advantages.