| Objective:To summarize and investigate the diagnosis,surgical methods and prognosis of insulinoma.Methods:A retrospective analysis of clinical data of 41 patients with insulinoma at the First Affiliated Hospital of Kunming Medical University from June 2008 to december 2017.Results:1.In this study,male patients accounted for 36.6%,female patients 63.4%,male-to-female ratio was 1:1.73,mean age of onset was 43.4±10.7 years,and the mean diameter of tumor was 1.7±0.44 cm.Insulinomas were distributed on the head,body and tail of the pancreas.It respectively accounted for 26.8%,34.2%and 39.0%.There were 37 benign tumors and 4 malignant tumors.2.All patients had different degrees of Whipple triad performance,fasting blood glucose fluctuations in the overall 1.4?4.2 mmol/L,4 patients insulin release index(IRI/G)<0.3,the rest IRI/G>0.3.All patients make routine imaging examination before the operation,abdominal B ultrasound in 41 cases,the diagnostic rate of 60.9%(25/41);enhanced CT in 32 cases,the diagnostic rate was 84.3%(27/32);MRI in 22 cases,the diagnostic rate was 90.9%(20/22).Intraoperative ultrasound examination in 8 cases,the diagnostic rate was 100%(8/8).3.All patients underwent surgical treatment.25 cases(60.9%)underwent the simple enucleation,9 cases(22.0%)underwent the resection of pancreatic body and tail,3 cases(7.4%)underwent mid-pancreatic resection,and 4 cases underwent pancreaticoduodenectomy(9.7%).4.All patients had significantly relief clinical symptoms after surgery.In the simple enucleation group,the operative time was 158.4±26.7 minutes,the blood loss was 64.8±15.6 ml,and the postoperative hospital stay time was 5.7±0.8 days;the partial pancreatectomy group had a operative time of 229.3±78.4 minutes and a blood loss of 116.3±46.6 ml,the postoperative hospital stay time was 7.4± 1.9 days.5.All patients showed varying degrees of reactive hyperglycemia after surgery.In the simple enucleation group,the pancreatic fistula was 28%(7/25)in grade A,8%(2/25)in grade B,and 4%(1/25)in acute pancreatitis,the incidence of incision infection was 4%(1/25),no:intra-abdominal infection and delayed gastric emptying were observed after surgery;in part of pancreatectomy groups,pancreatic fistula was 31.2%(5/16)for grade A and 18.7%(3/16)for grade B,delayed gastric emptying was 6.2%(1/16),the incidence of postoperative intra-abdominal infection was 6.2%(1/16),incision infection was 6.2%(1/16),there was no postoperative acute pancreatitis case.Conclusions:1.Enhanced CT and MRI are used for the diagnosis of insulinoma,it is convenient,noninvasive,and accurate.It can be used as the first choice for imaging examination.2.Surgical treatment is an effective method for radical removal insulinoma,higher incidence of pancreatic fistula and reactive hyperglycemia was observed after insulinoma surgery.The simple enucleation is the main surgical method for insulinoma.3.Compared with partial pancreatectomy,simple tumor enucleation has the advantages of less surgical trauma,less intraoperative blood loss,shorter operative time,lighter postoperative complications,and faster recovery. |
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