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目的：分析功能性胰岛素瘤误诊原因，评价多种定位诊断和术中监测措施。方法：该院近１５年共收治胰岛素瘤３１例，２３例出现典型的Ｗｈｉｐｐｌｅ三联症，病程中曾误诊为癔病７例，癫痫５例，精神分裂症４例，脑血栓２例，脑出血及散发性脑炎各１例，误诊率达６４．５％（２０／３１）。空腹血糖或发作血糖平均为２．１ｍｍｏｌ／Ｌ，空腹血胰岛素平均为３１．７ｍＩＵ／Ｌ。Ｂ超及电子计算机体层扫描（ＣＴ）检查阳性率分别为３８．７％（１２／３１）、４０．７％（１１／２７）。结果：术中探查扪诊正确率为１００％（３１／３１），其中２７例行单纯胰岛素瘤摘除术，２例行胰体尾切除术，２例胰颈部肿瘤摘除及胰体尾空肠Ｒｏｕｘ－ｅｎ－Ｙ吻合术。肿瘤切除后血糖即显著升高，２～５ｍｉｎ、１５ｍｉｎ、３０ｍｉｎ、６０ｍｉｎ、９０ｍｉｎ、１２０ｍｉｎ、１８０ｍｉｎ、２４ｈ、４８ｈ、７２ｈ血糖均值分别为５．９、７．７、８．４、９．７、１１．６、１３．４、１３．６、１３．５、１１．８、９．３ｍｍｏｌ／Ｌ。结论：①误诊原因：胰岛素瘤少见，低血糖症有多种原因，检查方法存在局限。②诊断方面：关键是考虑到此病，定位诊断尤为重要，以术中的细致触诊最为重要。③术中活检和动态血?
OBJECTIVE: To analyze the causes of misdiagnosis of functional insulinoma and to evaluate various positioning diagnosis and intraoperative monitoring measures. Methods: The hospital treated 31 cases of insulinoma in the past 15 years, 23 cases showed typical Whipple triad disease, 7 cases had been misdiagnosed as rickets in the course of disease, 5 cases of epilepsy, 4 cases of schizophrenia, 2 cases of cerebral thrombosis, cerebral hemorrhage and Sporadic encephalitis in 1 case, the misdiagnosis rate was 64.5% (20/31). Fasting blood glucose or stroke blood glucose average of 2.1mmol / L, fasting blood insulin average of 31.7mIU / L. The positive rates of B ultrasound and computed tomography (CT) examination were 38.7% (12/31) and 40.7% (11/27), respectively. Results: The accuracy of intraoperative exploration was 100% (31/31). Among them, 27 patients underwent simple insulinoma excision, 2 patients underwent pancreatic body excision, 2 pancreatic tumor resection and Roux -en-Y anastomosis. After the resection of the tumor, the blood glucose level increased significantly. The average blood glucose level at 2 ~ 5min, 15min, 30min, 60min, 90min, 120min, 180min, 24h, 48h, 72h were 5.9, 7.7, 8.4, 13.6, 13.5, 11.8, and 9.3 mmol / L. Conclusions: ① misdiagnosis reasons: rare insulinoma, hypoglycemia for many reasons, there are limitations in the examination methods. ② diagnosis: the key is to take into account the disease, positioning diagnosis is particularly important to intraoperative meticulous palpation is the most important. ③ intraoperative biopsy and dynamic blood?