Diagnosis and treatment of insulinoma:a report of 30 cases / 中国普通外科杂志

ABSTRACT

Objective To discuss the diagnosis and treatment of insulinoma.Methods The clinical data of 30 patients with insulinoma were reviewed.Results All patients had Whipple′s triad.Accurate preoperative localization rate of B ultrasonography, CT and MRI was 34.8 %(8/23),58.3 %(7/12) and 71.4 %(5/7),respectively. Localization rate of intraoperative ultrasonography (IOUS) was 87.5 %(7/8). The tumors were single in 27 cases,and multiple in 3 cases. In the location of single tumor,8 of them were in the head,7 in the body, and 12 in the tail; while for multiple tumors, 2 tumors were both located in the body in 1 patient,and 2 tumors were separately located in the body and tail respectively in 2 patients. Local enucleation was performed in 21 cases, distal pancreatectomy in 6 cases,distal pancreatectomy plus splenectomy in 2 cases,and duodenopancreatectomy in 1 case. The tumor was benign in 29 cases, and malignant in 1 case.Pancreatic fistula developed after operation in 4 cases, and in all cases, it healed after drainage. All patients had no symptoms of hypoglycemia after operation. At follow-up visit in 27 cases, 1 case of benign tumor recurred 4 years after operation, and was cured by resection of the pancreas body with tumor; the malignant tumor case, recurred and died of metastasis of abdominal cavity 3 years after operation.Conclusions Whipple′s triad, and the ratio of immunoreactive insulin to blood glucose (IRI/G)are the bases for qualitative diagnosis of insulinoma. Meticulously palpating the gland combined with IOUS during operation is the most effective method for accurate tumor localization. Enucleation is the main mode of surgical treatment of insulinoma.