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胰岛素瘤的定位及其多发性、异位性、隐匿性肿瘤的发现是外科治疗的难题。为提高手术成功率，减少复发率，对近24年来华山医院外科治疗的42例胰岛细胞瘤进行临床分析。结果表明，胰岛素瘤是胰岛细胞瘤中最常见者，胰岛素瘤的诊断不难，多有典型的Whipple三联症表现，但术前定位不易，主要依靠B超、选择性动脉造影和CT检查，术后复发率较高（23．8％），主要原因为肿瘤残留。7例术后复发再次手术，其中5例探查发现胰岛素瘤，切除肿瘤后治愈。术前不必过多致力于定位诊断，术中充分显露胰腺，过细的触摸胰腺各个区域是发现肿瘤的主要手段。如不能发现肿瘤，力争做术中B超，术中门静脉置管，分段取血测定胰岛素峰值位置，可指导手术，减少盲目性胰体尾切除。肿瘤完全切除是治疗成功的关键。
The location of insulinomas and the discovery of multiple, ectopic, and occult tumors are problems for surgical treatment. To improve the success rate of surgery and reduce the recurrence rate, 42 cases of islet cell tumors surgically treated by Huashan Hospital in the past 24 years were clinically analyzed. The results showed that insulinoma is the most common one in islet cell tumors. The diagnosis of insulinoma is not difficult. There are typical Whipple triads, but the preoperative positioning is not easy, mainly rely on B-mode ultrasound, selective angiography and CT examination. After the recurrence rate is higher (23.8%), mainly due to residual tumors. Seven cases of recurrence after reoperation, of which 5 cases discovered insulinoma, cured after removal of the tumor. Preoperative do not have to devote too much to the positioning diagnosis, the pancreas is fully exposed during surgery, and touching the various regions of the pancreas is the main method for finding tumors. If you cannot find a tumor, strive to do intraoperative B-ultrasound, intraoperative portal vein catheterization, segmental blood sampling to determine the peak insulin position, can guide surgery, reduce blind pancreatic body and tail end resection. Complete removal of the tumor is the key to successful treatment.