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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。
Objective To investigate the clinical features, diagnosis and treatment of islet cell tumor and its prognosis. Methods The clinical features, diagnosis, treatment and prognosis of 18 patients with islet cell tumor admitted to the First Hospital of Peking University from January 2000 to April 2013 were retrospectively analyzed. Results Among the 18 patients, the male-to-female ratio was 1: 2. The age ranged from 18 to 83 years and the median age was 51 years. 16 cases were functional islet cell tumors, 2 cases were non-functional islet cell tumors, functional islet cell tumors were insulinomas, of which 2 cases with diabetes. Insulinoma patients are clinically typical Whipple triad; blood glucose 0.85 ~ 2.56mmol / L, while insulin levels> 10 mU / L in 16 cases, insulin release index> 0.4 in 11 cases, insulin release correction index> 100 There are 14 cases. Insulinoma patients underwent B ultrasound examination in 11 cases, 5 cases were positive; line enhanced CT examination in 14 cases, 11 cases were positive. Three patients with negative B and CT were diagnosed by endoscopic ultrasonography, percutaneous transhepatic portal vein catheterization, PTPC, B laparotomy and segmental blood sampling. Twenty-seven patients with islet cell tumor underwent surgical treatment, including 10 cases of tumor resection, 6 cases of pancreatic tail resection and 1 case of Whipple operation. None of the patients had serious complications after operation, and postoperative hypoglycemia of insulinoma patients recovered. Conclusion The majority of islet cell tumor with functional insulinoma and a few with diabetes mellitus should be diagnosed by Whipple triad. The diagnosis of islet cell tumor is qualitatively diagnosed by insulin and insulin release index. The positive rate of enhanced CT examination is high. Islet cell tumor of high benign rate, the main surgical treatment.