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目的分析胰岛素瘤的临床表现特点,为诊断和治疗提供帮助。方法回顾性分析2000年10月至2006年4月北京大学第一医院住院手术且术后病理诊断的胰岛素瘤10例临床资料。结果(1)10例患者均表现有晨起或饥饿时发作性出冷汗、心慌等交感神经兴奋及头晕、乏力症状,其中9例进食或喝糖水后可缓解。9例有晕厥、昏迷等意识障碍,6例有惊厥、抽搐或癫发作,5例进食多且体重增加超过10kg。(2)8例血糖<2.8mmol/L,7例胰岛素血糖比值>0.4,9例胰岛素修正释放指数>100。(3)B超、CT和术中探查阳性率分别为30%、60%和100%。结论典型低血糖症状、Whipple三联症和胰岛素血糖比值、胰岛素修正释放指数是胰岛素瘤定性诊断主要依据,术中B超结合术中探查和脾门静脉分段取血是最有效的肿瘤定位手段。临床表现典型而影像学检查阴性病例应考虑剖腹探查术。
Objective To analyze the clinical manifestations of insulinomas and provide help for diagnosis and treatment. Methods The clinical data of 10 cases of insulinoma diagnosed by inpatients and postoperative pathology from October 2000 to April 2006 in Peking University First Hospital were retrospectively analyzed. Results (1) All 10 patients showed symptoms of sympathetic excitement such as cold sweat and palpitation and dizziness and weakness symptoms during morning sickness or starvation. Among them, 9 cases were relieved by eating or drinking syrup. 9 cases had syncope, coma and other disturbance of consciousness, 6 cases had seizures, convulsions or epileptic seizures, 5 cases of eating more and weight gain over 10kg. (2) 8 cases of blood glucose <2.8mmol / L, 7 cases of insulin blood glucose ratio> 0.4, 9 cases of insulin modified release index> 100. (3) The positive rates of B ultrasound, CT and intraoperative exploration were 30%, 60% and 100% respectively. Conclusion The typical symptoms of hypoglycemia, Whipple triple disease and insulin blood glucose and insulin release release index are the main basis for the qualitative diagnosis of insulinoma. Intraoperative B-ultrasound exploration and splenomegaly portal vein blood sampling are the most effective tumor localization methods. Typical clinical manifestations and imaging studies negative cases should consider laparotomy.