Diagnosis and treatment of insulinoma

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Author:
XU Ju-ping(Department of General Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China)
ZHAO Yong-fu(Department of General Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China)
ZHANG Shui-jun(Department of General Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China)
LIU Lei(Department of General Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China)
ZHAI Wen-long(Department of General Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China)
Journal Title:
CHINESE JOURNAL OF PANCREATOLOGY
Issue:
Volume 9, Issue 04, 2009
DOI:
10.3760/cma.j.issn.1674-1935.2009.04.008
Key Word:
Insulinoma; Diagnosis; Treatment; B-ultrasound, intra-operative; Surgical

Abstract: Objective To summarize the diagnosis and therapeutic experience of insulinoma in order to improve the surgical success rate and prognosis. Methods The clinical data of 138 patients with insulinoma from 1966 to 2007 were retrospectively analyzed. Results In this group of patients, hypoglycemia of different levels and Whipple triad were detected. 64 patients expressed different psychic symptom, 12 patients' psychic symptom were still present after blood glucose normalized after operation. Fasting serum insulin values in 88 patients were measured, and the insulin release index was higher than 0. 3. Before operation, tumor was detected in 8 of 75 patients by B-ultrasound scan, and in 17 of 68 patients by CT, and in 5 of 10 patients by MRI. The intra-operative B-ultrasound (IOUS) examination was applied in 44 cases, and 43 cases were successfully detected. The operations included enucleation of insulinoma (n=88) , resection of the body and tail of pancreass (n = 44) , pancreaticoduodenectomy (n=2) , and biopsy (n=1). The blood glucose symptoms normalized postoperatively in 132 patients. The blood glucose rebound in 110 patients, but blood glucose normalized within 2 weeks. After operation, 20 patients developed pancreatic fistula, 32 patients developed acute pancreatitis. Conclusions Insulinoma could be qualitatively diagnosed according to Whipple triad and the insulin release index. Operations with IOUS were simple and effective methods to localize the tumors. The only way to cure insulinoma was operation, and IOUS guided operation could avoid main pancreatic duct and vessel injury, decrease post-operative complications.

  • [1]杨志英,刘展,赵平,等.1078例胰岛素瘤的定位诊断.外科理论与实践,2001,6:87-89.
  • [2]Piter J,Soubrane O,Dousset B,et al.Pancreatic echo-endoscopy and preoperative localization of insulinomas.Ann Chir,1998,52:369-373.
  • [3]陈富六.动脉激发静脉采血检查对胰岛素瘤术前功能性定位的价值.诊断学理论与实践,2002,1:186-187.
  • [4]Rothmund M.Surgery for benign insulinomas an international review.World J Sury,1990,14:393-398.
  • [5]涂柳果,张国华.术中脾门静脉血胰岛素测定作胰岛素瘤定位的研究.中华内分泌代谢杂志,1987,3:172-173.
  • [6]赵永福,韩文豪,吴阳,等.胰岛素瘤的术前及术中定位诊断方法的探讨.中华胰腺病杂志,2008,8:157-159.
  • [7]Fendrich V,Bartach DK,Langer P,et al.Diagnosis and surgical treatment of insulinoma-experiences in 40 cases.Dtsch Med Wochenschr,2004,129:941-946.
  • [8]王磊,赵玉沛,陈革.恶性胰岛素瘤的诊断和治疗.肝胆外科杂志,2004,12:88-90.
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