Third Department of Surgery, Athens General Hospital, Athens, Greece.
Hepatobiliary Pancreat Dis Int. 2010 Jun;9(3):234-41.
Although insulinomas are very rare tumors, they are the most common pancreatic neuroendocrine neoplasms. The incidence in general population is 1-4 per 1,000,000 yearly but the incidence is higher in autopsy studies. The malignancy of insulinomas is difficult to be predicted on the basis of their histological features, and the current WHO classification has been re-evaluated. This review aimed to summarize classical knowledge with current trends in the diagnosis and treatment of insulinomas.
A Medline search using terms "insulinoma", "treatment" and "neuroendocrine tumors" was conducted. Additional references were sourced from key articles.
Surgery is the treatment of choice for insulinoma and has an extremely high success rate. Medical treatment is also available but only for patients who are unable or unwilling to undergo surgical treatment. Preoperative localization is necessary for planning the surgical approach. Many methods exist for localization of an insulinoma and can be invasive and non-invasive. The combination of biphasic thin section helical CT and endoscopic ultrasonography (EUS) has an almost 100% sensitivity in localizing insulinomas. Laparoscopic ultrasound is mandatory to localize intraoperatively these tumors. EUS-guided fine needle tattooing is an alternative method of localization in case of lack of laparoscopic ultrasound.
Laparoscopic resection for benign insulinomas is the procedure of choice, whereas pancreatectomy is reserved for large, potentially malignant tumors.
尽管胰岛素瘤是非常罕见的肿瘤，但它们是最常见的胰腺神经内分泌肿瘤。一般人群的年发病率为 1-4/100 万，但尸检研究中的发病率更高。胰岛素瘤的恶性程度难以根据其组织学特征预测，目前的 WHO 分类已经重新评估。本综述旨在总结胰岛素瘤诊断和治疗方面的经典知识和当前趋势。
使用“胰岛素瘤”、“治疗”和“神经内分泌肿瘤”等术语进行 Medline 搜索。还从关键文章中获取了其他参考文献。
手术是胰岛素瘤的首选治疗方法，成功率极高。也可以进行药物治疗，但仅适用于无法或不愿接受手术治疗的患者。术前定位对于规划手术方法是必要的。有许多方法可用于定位胰岛素瘤，可以是有创的和无创的。双相薄层螺旋 CT 和内镜超声（EUS）的结合在定位胰岛素瘤方面具有近 100%的敏感性。腹腔镜超声是术中定位这些肿瘤的强制性方法。如果缺乏腹腔镜超声，可以选择 EUS 引导下的细针穿刺标记作为替代定位方法。
对于良性胰岛素瘤，腹腔镜切除术是首选方法，而胰切除术则保留用于大的、可能恶性的肿瘤。
