Tavcar Ivan, Kiković Sasa, Bezmarević Mihailo, Rusović Sinisa, Perisić Nenad, Mirković Darko, Kuzmić-Janković Snezana, Dragović Tamara, Karajović Jelena, Sekulović Leposava, Hajduković Zoran
Vojnosanit Pregl. 2014 Mar;71(3):293-7. doi: 10.2298/vsp130415048t.
BACKGROUND/AIM: Insulinomas are rare benign tumors in the most cases and the most frequent endocrine tumors of the pancreas. A wide spectrum of clinical manifestations in patients with insulinoma is the reason for difficult recognition of the disease with a long period of time between the onset of symptoms and the diagnosis. Diagnostic procedures include Whipple's triad, 72-hour fast test and topographic assessment. The only currative therapy for patients with insulinoma is operative treatment.
This retrospective study included 42 patients with diagnosis of insulinoma treated in our institution in a 60-year period. In all the patients a demographic and clinical data, types of biochemical methods for diagnosis, and diagnostic procedures for insulinoma localization were analyzed. Tumor size and localization, surgical procedures, postoperative complications and outcome were assessed.
A study included 42 patients, 29 women and 13 men. The median age at diagnosis was 43 years. Median time between the onset of symptoms and diagnosis was 3 years. The most common clinical symptoms and signs were disturbance of consciousness and abnormal behavior in 73%, confusion and convulsions in 61% of patients. The diagnosis of insulinoma was estimated by Whipple's triad and 72-hour fast test in 14 patients. Determination of insulinoma localization was assessed by angiography in 16 (36%) of the patients, by ultrasound (US) in 3 of 16 (18.8%) patients, by abdominal computed tomography (CT) in 8 of 18 (44.5%) patients, and magnetic resonance imaging (MRI) in 2 of 8 (25%) patients. Insulinoma was found in 13 of 13 (100%) patients by arterial stimulation with venous sampling (ASVS) and in 13 of 14 (93%) patients by endoscopic ultrasound (EUS). Of the 42 patients, 38 (90.5%) underwent operative procedure. Minimal resection was performed in 28 (73.6%) of the patients [tumor enucleation in 27 (71%) and central pancreatectomy in one (2.6%) of the patients], and the major resection was performed in 9 (23.6%) of the operated patients [distal splenopancreatectomy in 8 (21%) and pancreaticoduodenectomy in one (2.6%) patient]. The overall mortality rate in postoperative period was 2.6% (one patient).
A combination of ASVS and EUS as diagnostic procedures ensures high accuracy for preoperative determination of insulinoma localization. Minimal resection such as enucleation shoud be performed whenever it is possible.
背景/目的：胰岛素瘤在大多数情况下是罕见的良性肿瘤，是胰腺最常见的内分泌肿瘤。胰岛素瘤患者临床表现多样，这导致疾病难以识别，从症状出现到诊断的时间间隔较长。诊断方法包括惠普尔三联征、72小时禁食试验和定位评估。胰岛素瘤患者唯一的治愈性治疗方法是手术治疗。
这项回顾性研究纳入了60年间在我们机构接受治疗的42例诊断为胰岛素瘤的患者。分析了所有患者的人口统计学和临床数据、诊断用生化方法的类型以及胰岛素瘤定位的诊断程序。评估了肿瘤大小和定位、手术程序、术后并发症及结果。
该研究纳入42例患者，其中女性29例，男性13例。诊断时的中位年龄为43岁。症状出现至诊断的中位时间为3年。最常见的临床症状和体征为意识障碍和异常行为（73%），意识模糊和抽搐（61%）。14例患者通过惠普尔三联征和72小时禁食试验诊断为胰岛素瘤。16例（36%）患者通过血管造影评估胰岛素瘤定位，16例中的3例（18.8%）通过超声（US），18例中的8例（44.5%）通过腹部计算机断层扫描（CT），8例中的2例（25%）通过磁共振成像（MRI）。13例患者通过动脉刺激静脉采血（ASVS）均发现胰岛素瘤（100%），14例中的13例（93%）通过内镜超声（EUS）发现。42例患者中，38例（90.5%）接受了手术。28例（73.6%）患者进行了最小化切除[27例（71%）行肿瘤剜除术，1例（2.6%）行胰体尾切除术]，9例（23.6%）手术患者进行了扩大切除[8例（21%）行远端脾胰切除术，1例（2.6%）行胰十二指肠切除术]。术后总死亡率为2.6%（1例患者）。
ASVS和EUS联合作为诊断程序可确保术前胰岛素瘤定位的高准确性。只要可能，应进行如剜除术这样的最小化切除。
