Ambacher T, Kasperk R, Schumpelick V
Chirurgische Universitätsklinik und Poliklinik der RWTH Aachen.
Chirurg. 1999 Mar;70(3):298-301. doi: 10.1007/s001040050647.
An insulinoma is the most common pancreatic endocrine tumor. Typical is the presence of a solitary tumor. In 10% of the cases an insulinoma may occur in multiple sites, especially in MEN syndrome. Malignant insulinomas appear in 10% of cases. Insulinomas occur at every age, but mainly about the 50th year. Because of its small size (a diameter of 1-2 cm) diagnostic localization is often difficult. With costly imaging techniques such as CT and MRI, only 60% of the adenomas can be detected preoperatively. If reoperation is a possibility, CT and MRI are advisable. Based on our own experience and the reports of other authors, we advise the combination of transabdominal ultrasound and endosonography for the primary operation. With these methods 90% of the adenomas can be localized preoperatively. If the clinical and biochemical insulinoma diagnosis is definite, explorative laparotomy is indicated even without preoperative morphological tumor detection. With intraoperative ultrasound and systematic palpation more than 97% of insulinomas can be found and resected. We report the case of a 54-year-old woman with unsuccessful preoperative localization in spite of extensive clinical, biochemical and imaging procedures over a 6-month period.
胰岛素瘤是最常见的胰腺内分泌肿瘤。典型表现为存在单个肿瘤。10%的病例中，胰岛素瘤可能发生于多个部位，尤其是在多发性内分泌腺瘤综合征中。10%的病例会出现恶性胰岛素瘤。胰岛素瘤可发生于任何年龄，但主要在50岁左右。由于其体积小（直径1 - 2厘米），诊断性定位往往困难。使用如CT和MRI等昂贵的成像技术，术前仅能检测出60%的腺瘤。如果有可能再次手术，CT和MRI是可取的。根据我们自己的经验以及其他作者的报告，我们建议在初次手术时联合使用经腹超声和内镜超声检查。通过这些方法，90%的腺瘤可在术前定位。如果临床和生化胰岛素瘤诊断明确，即使术前未检测到形态学上的肿瘤，也应进行探查性剖腹手术。术中使用超声并进行系统触诊，97%以上的胰岛素瘤能够被发现并切除。我们报告了一例54岁女性患者的病例，尽管在6个月内进行了广泛的临床、生化和成像检查，术前定位仍未成功。
