•大会交流•胰岛素瘤64例的诊断与外科治疗杨维良张好刚张浩民王惠良迟强王夫景150086,哈尔滨医科人学附属第二医院普外科(杨维良、张好刚、迟强、王夫景)；161000,齐齐哈尔医学院普外科(张浩民)；157400,牡丹江市第二医院普外科(王惠良)【摘要】目的总结胰岛素瘤的诊断与外科治疗方法。方法回顾性分析64例胰岛素瘤的临床资料。结果64例均表现Whipple三联征。术前BUS、CT及强化CT、MRLDSA诊断阳性率分别为46.9%(30/64),58.2%(23/39),66.7%(18/27),91.7%(11/12)。I0US诊断阳性率为92%(23/25)。单个肿瘤58例，多发肿瘤6例。单发者位于胰头19例，其中直径4cm1例，胰体17例，胰尾22例；多发者6例均为2枚肿瘤，4例位于胰体，2例分别位于胰体和胰尾各1枚。治疗行肿瘤局部切除39例，胰体尾切除13例加作脾切除6例，胰尾切除8例加作脾切除4例，脇体表面肿瘤直径2cm行腹腔镜下单纯肿瘤摘除1例，自左向右分段切除(盲切法)2例，行胰头十二指肠切除1例。良性肿瘤62例，恶性2例。术后胰痿3例、急性胰腺炎4例均经非手术治愈。64例术后低血糖症状消失。62例良性胰岛素瘤术后随诊1〜5年血糖正常，其中2例分别于术后4年和5年复发，再次手术发现胰尾近脾门处分别有肓径lcm和1.5cm肿瘤，经胰尾切除示治愈。45例随访8年血糖正常，17例失访。2例恶性胰岛索瘤分别于术后3年和4年复发，因川•转移死亡。结论Whipple三联征和测定IRI/O0.3是定性诊断的依据。术中触诊联合I0US是最有效的肿瘤定位诊断方法。胰岛素瘤切除术是最佳的治疗方法。【关键词】胰岛索瘤；诊断；治疗【中图法分类号】R736.7【文献标识码】BDiagnosisandSurgicalTreatmentofinsulinomain64PatientsYANGWei-liang^,ZHANGHao-gang,ZHANGHao-inin,WANGHui-licmg,CHIQiang,WANGFu-jing.DepartmentofGeneralSurgery.SecondAffiliatedHospitalofHarbinMedicalUniversity,Harbin150086,China[Abstract]ObjectiveTosummarizediagnosisandsurgicaltreatmentofinsulinoma.MethodsClinicaldataof64patientswithinsulinomafrom1980to2006wereanalyzedretrospectively.ResultsAllpatientshadWhipple'striad・AccurateprcopcrativclocalizationrateofBultrasonography,CTandEnhancedCT,MRI,DSAwas46.9%(30/64),5&2%(23/39)and91・7%(11/12),respectively.Localizationrateofintraoperativeultrasonography(IOUS)was92%(23/25).Thetumorsweresinglein58cases,andmultiplein6cases・Inthelocationofsingletumor,19ofthemwereinthehead,17inthebody,and22inthetail;whileformultipletumors,2tumorswerebothlocatedinthebodyin4patient,and2tumorswereseparatelylocatedinthebodyandtailrespectivelyin2patients.TreatmentLocalenucleationwasperformedin39cases,resectionofpancreaticbodyandtailin13cases,resectionofpancreaticbodyandtailplussplenectomyin6cases,resectionofpancreatictailin8cases,resectionofpancreatictailplussplenectomyin4cases,laparoscopicresectionofinsulinomain1case,piecewiseresectionofpancreasfromlefttoright(blindresection)in2cases,pancreaticoduodenectomyin1case.Thetumorwasbenignin62cases,andmalignantin2cases.Pancreaticfistuladevelopedafteroperationin3eases,acutepancreatitisin4eases,andintheseeases,theyhealedafternon-operativetreatment.Allpatientshadnosymptomsofhypoglycemiaafteroperation・Atfollow-upvisitin62cases,2caseofbenigntumorrecurred4yearsafteroperation,andwascuredbyresectionofthepancreasbodywithtumor;2malignanttumorscases,recurredanddiedofhepaticmetastasisin3yearsand4yearsafteroperation.ConclusionsWhipple'striadandIRI/G>0・3arcthebasesforqualitativediagnosisofinsulinoma.MeticulouslypalpatingtheglandcombinedwithIOUSduringoperationisthemosteffectivemethodforaccuratetumorlocalization.Resectionofinsulinomaisthebestmodeofsurgicaltreatmentofinsulinoma・【Keywords]insulinoma;diagnosis;treatment胰岛素瘤是起源于胰岛B细胞的一种少见疾病，年...