Kuzin N M, Egorov A V, Kondrashin S A, Lotov A N, Kuznetzov N S, Majorova J B
Department of Surgery No. 1, Moscow Medical Academy, Russia.
World J Surg. 1998 Jun;22(6):593-7; discussion 597-8. doi: 10.1007/s002689900440.
Altogether 120 patients with organic hyperinsulinism underwent clinical examination and treatment (38 male, 82 female, mean age 44.2 +/- 4.6 years). The cause of hyperinsulinism was benign insulinomas in 96 (80.0%), malignant tumors in 9 (7.5%), and hyperplasia of beta cells in 6 (5.0%). In 9 (7.5%) patients the origin of hyperinsulinism was not diagnosed. The tumor was localized in the head, body, and tail of the pancreas in 31.8%, 36.4%, and 31.8% of cases, respectively. Intraoperative ultrasonography (IOUS) was undertaken in 37 patients, and in 83 cases only intraoperative palpation was done. Arterial stimulated venous sampling (ASVS) was performed in 17 patients (blood was sampled from the right hepatic vein for determination of the insulin level after arterial stimulation by calcium gluconate in different parts of the pancreas). The sensitivity of ultrasonography (US) was 29.5%, computed tomography (CT) 24.2%, angiography 55.9%, superselective angiography (branches of the celiac trunk) 72.2%, and intraoperative palpation 90.0%. ASVS showed an accuracy of 90.0%. Combining angiography with ASVS gave an exact diagnosis of hyperinsulinism in 100% of cases, and IOUS revealed tumors in 100% of cases. Hyperplasia of beta-cells was diagnosed only by means of ASVS. A total of 117 patients underwent surgery, including distal resection of pancreas (n = 39), enucleation of tumor (n = 70), and laparotomy (n = 8). The postoperative mortality associated with insulinomas was 7.7%. The frequency of postoperative complications was 43.6%. Benign insulinomas recurred at a rate of 5.4%. Patients with malignant insulinomas had a 5-year survival of 66.0%. The diagnosis of insulinomas was achieved by a combination of selective angiography, ASVS, and IOUS.
共有120例器质性高胰岛素血症患者接受了临床检查和治疗（男性38例，女性82例，平均年龄44.2±4.6岁）。高胰岛素血症的病因中，96例（80.0%）为良性胰岛素瘤，9例（7.5%）为恶性肿瘤，6例（5.0%）为β细胞增生。9例（7.5%）患者的高胰岛素血症病因未明确诊断。肿瘤分别位于胰腺头部、体部和尾部的病例占31.8%、36.4%和31.8%。37例患者进行了术中超声检查（IOUS），83例仅进行了术中触诊。17例患者进行了动脉刺激静脉采血（ASVS）（通过葡萄糖酸钙在胰腺不同部位进行动脉刺激后，从右肝静脉采血测定胰岛素水平）。超声检查（US）的敏感性为29.5%，计算机断层扫描（CT）为24.2%，血管造影为55.9%，超选择性血管造影（腹腔干分支）为72.2%，术中触诊为90.0%。ASVS的准确率为90.0%。血管造影与ASVS联合应用在100%的病例中能准确诊断高胰岛素血症，IOUS在100%的病例中能发现肿瘤。β细胞增生仅通过ASVS诊断。共有117例患者接受了手术，包括胰腺远端切除术（n = 39）、肿瘤摘除术（n = 70）和剖腹探查术（n = 8）。胰岛素瘤相关的术后死亡率为7.7%。术后并发症发生率为43.6%。良性胰岛素瘤的复发率为5.4%。恶性胰岛素瘤患者的5年生存率为66.0%。胰岛素瘤的诊断通过选择性血管造影、ASVS和IOUS联合实现。
