【摘要】    目的    探讨胰岛素瘤的诊断和治疗方法。方法    回顾性分析南通市瑞慈医院和南通市第一人民医院近15年来治疗的22例胰岛素瘤的临床资料。结果    全组22例均有Whipple三联征。术前B超、CT、MRI、门静脉穿刺分段取血胰岛素测定诊断的阳性率分别为15.8%（3/19）、67.5%（10/16）、71.4%（5/7）、100%（2/2），术中B超的诊断阳性率85.7%（6/7）。行肿瘤局部切除13例，胰体尾切除3例，胰体尾切除+脾脏切除1例，胰十二指肠切除1例，保留十二指肠的胰头切除1例，腹腔镜下胰岛素瘤切除3例。22例均为良性肿瘤。术后低血糖症状均消失。结论    Whipple三联征结合IRI/G比例的测定是定性诊断的主要依据。多层螺旋CT双期胰腺薄层扫描是定位诊断的主要手段，术中B超是对术前定位诊断的检验和补充。肿瘤切除是胰岛素瘤的主要术式，腹腔镜胰岛素瘤切除应得到推崇。

Diagnosis and treatment of insulinoma:analysis of  22 case        YANG Jun-feng*，SHA Cong，TIAN Ming-guo, et al. *Department of General Suregery, Nantong Rich Hospital, Nantong 226010,China
Corresponding author：YANG Jun-feng，E-mail:richyjf@sina.com
Abstract    Objective    To explore the diagnosis and management of insulinoma. Methods    The clinical data of 22 cases of insulinoma treated in the past 15 years were analyzed retrospectively. Results    All 22 cases had the signs of whipple triad. The positive rate of preoperative BUS,CT,MRI and selective portal vein sampling as well as intraoperative BUS were respectively 15.8%(3/19),67.5%(10/16),71.4%(5/7),100%(2/2) and 85.7%(6/7). The operation methods included tumor enucleation in 13cases, distal pancreatic resection in 3 cases, distal pancreatic resection plus splenectomy in1 case, Whipple’s procedure in1 case, resection of pancreatic head with preservation of the duodenum in1 case and laparoscopic enucleation of the tumor under laparoscopy in 3 cases. All tumors were pathologically benign. Hypoglycemia disappeared after resection in all cases. Conclusion    Whipple’s triad combined with IRI/G ratio measurement are still the main qualitation diagnosis. Two stage spinal CT thin scanning is the main method for tumor location. Intraoperative BUS is the supplement to preoperative location diagnosis. Tumor resection is the effective therapeutic method. Laparoscopic tumor enucleation should be recommended.