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目的探讨功能性胰岛β细胞瘤的诊断和治疗方法。方法收集我院1998年4月至2008年4月收治的42例功能性胰岛β细胞瘤患者的临床资料,对其临床表现、检查手段和治疗结果进行回顾性分析。结果42例患者均有Whipple三联征,IRI/G>0.3有39例。术前行B超和CT检查,分别发现16例(38),32例(76),术前B超联合CT检查发现34例(81),术中B超联合扪诊发现40例(95)。肿瘤位于胰头15例,胰体12例,胰尾15例;术后病理证实良性肿瘤40例,胰岛细胞增生1例,恶性1例。单纯肿瘤切除25例;胰体尾联合脾切除6例;单纯胰体尾切除9例,1例联合左肾切除;胰十二指肠切除2例。术后胰漏5例,4例为肿瘤摘除者,1例为胰十二指肠切除。1例术后因多器官功能衰竭死亡。结论功能性胰岛β细胞瘤定位诊断尤其重要,术中B超是发现肿瘤较好的手段。手术方式取决于肿瘤大小和位置,合理的手术方式选择能减少术后并发症的发生。
Objective To investigate the diagnosis and treatment of functional islet β cell tumor. Methods The clinical data of 42 patients with functional islet β-cell carcinoma treated in our hospital from April 1998 to April 2008 were collected retrospectively. The clinical manifestations, examination methods and treatment results were retrospectively analyzed. Results 42 patients had Whipple triad, IRI / G> 0.3 in 39 cases. There were 16 cases (38 cases) and 32 cases (76 cases) preoperatively, and 34 cases (81 cases) were found by preoperative ultrasonography combined with CT. Forty cases (95 cases) were diagnosed by B- . The tumor was located in 15 cases of pancreatic head, pancreatic body in 12 cases, pancreatic tail in 15 cases; pathologically confirmed 40 cases of benign tumors, islet cell hyperplasia in 1 case, 1 case of malignancy. Simple tumor resection in 25 cases; pancreatic body tail combined with splenectomy in 6 cases; simple pancreatic tail resection in 9 cases, 1 case combined with left nephrectomy; pancreatoduodenectomy in 2 cases. Postoperative pancreatic leakage in 5 cases, 4 cases of tumor removal, 1 case of pancreatoduodenectomy. One patient died of multiple organ failure after operation. Conclusion The diagnosis of functional islet β cell tumor is particularly important. The intraoperative ultrasonography is a good means to find the tumor. The surgical approach depends on the size and location of the tumor, and reasonable surgical options can reduce the incidence of postoperative complications.