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·论著·诊疗提示·

胰岛素瘤 15 例临床诊治分析

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陈琳光 ，于爱军 ，张学军 ，卜春红 2* 扫描二维码
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【摘要】 背景 胰岛素瘤是常见的功能性胰腺神经内分泌肿瘤，症状复杂多变，误诊率高，定位诊断及最佳治
疗是胰岛素瘤诊治过程中的重大挑战。目的 总结胰岛素瘤的诊治经验。方法 回顾性分析 2009—2019 年于承德医
学院附属医院接受外科手术治疗的 15 例胰岛素瘤患者的临床资料，总结其临床表现、定性诊断、定位诊断、手术方
式、术后情况及随访资料。结果 15 例患者中单发 13 例，多发 2 例，其中 1 例合并多发内分泌肿瘤 1 型（MEN-1）。
15 例患者均有 Whipple 三联征表现，胰岛素释放指数（IRI/G）均 >0.3。15 例患者均行经腹超声检查，无阳性发现；
行胰腺强化 CT 检查，阳性 14 例，阴性者进一步行 MRI 检查发现病灶。15 例患者均行手术治疗，9 例行肿瘤摘除术，
5 例行胰体尾切除术（4 例腹腔镜手术，1 例开腹手术），MEN-1 患者行保留幽门的胰十二指肠切除术（PPPD）+ 胰
尾肿瘤摘除术，术后病理均为良性胰岛素瘤。术后临床相关性胰瘘（B/C 级）4 例，无围术期死亡患者。术后患者血
糖均恢复正常且随访未见肿瘤复发及新发糖尿病患者。结论 Whipple 三联征结合 IRI/G 是术前定性诊断的主要依据。
胰腺增强 CT 及 MRI 是术前一线定位诊断手段，内镜超声（EUS）是重要的补充手段。手术切除是目前的一线治疗方案，
符合条件者首选肿瘤局部切除以充分保留胰腺功能。
【关键词】 胰岛素瘤；多发性内分泌肿瘤 1 型；诊断；外科治疗
【中图分类号】 R 736.7 【文献标识码】 B DOI：10.12114/j.issn.1007-9572.2022.0454
陈琳光，于爱军，张学军，等 . 胰岛素瘤 15 例临床诊治分析［J］. 中国全科医学，2022，25（29）：3698-3701.
［www.chinagp.net］
CHEN L G，YU A J，ZHANG X J，et al. Diagnosis and treatment of insulinoma：clinical analysis of 15 cases［J］.
Chinese General Practice，2022，25（29）：3698-3701.

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Diagnosis and Treatment of Insulinoma：Clinical Analysis of 15 Cases CHEN Linguang ，YU Aijun ，ZHANG Xuejun ，
BU Chunhong 2*
1.Department of Hepatobiliary Surgery，Affiliated Hospital of Chengde Medical University，Chengde 067000，China
2.ICU，Affiliated Hospital of Chengde Medical University，Chengde 067000，China
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Corresponding author：BU Chunhong，Associate chief physician；E-mail：doctorbch@163.com
【Abstract】 Background Insulinoma is a common functional pancreatic neuroendocrine tumor，with high possibility
of being misdiagnosed due to complex and changeable symptoms. Making a topical diagnosis and providing patients with the
optimal treatment are major challenges in the diagnosis and treatment of insulinoma. Objective To give a summary of our
experience of diagnosis and treatment of insulinoma. Methods A retrospective design was used. Participants were 15 insulinoma
patients who received surgical treatment in Affiliated Hospital of Chengde Medical University from 2009 to 2019. Their clinical
data（including clinical presentations，qualitative diagnosis，topical diagnosis，surgical approach，and postoperative
conditions），and follow-up data were summarized. Results Thirteen patients had solitary insulinoma，2 patients had multiple
insulinomas. One patient with multiple insulinomas also had multiple neuroendocrine tumor type 1（MEN-1）. All cases showed
Whipple's triad，with an insulin release index（IRI/G） greater than 0.3. All patients had negative results for transabdominal
ultrasonography. Fourteen patients had positive results for enhanced pancreatic CT，and the other one with negative results was
found with insulinoma by MRI. All patients underwent surgical resection，among whom 9 underwent insulinoma enucleation，5
underwent a distal pancreatectomy（4 used laparoscopic approach and 1 used open approach），the MEN-1 patient underwent
pylorus-preserving pancreaticoduodenectomy（PPPD） plus distal pancreatectomy. All tumors were pathologically benign.
There were 4 cases of postoperative clinically relevant pancreatic fistula （grade B/C），and there was no perioperative death.

基金项目：河北省自然科学基金资助项目（H2021406047）；承德市科学技术研究与发展计划（202006A087）
1.067000 河北省承德市，承德医学院附属医院肝胆外科 2.067000 河北省承德市，承德医学院附属医院重症医学科
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通信作者：卜春红，副主任医师；E-mail：doctorbch@163.com
本文数字出版日期：2022-07-08