Comparison And Significance Of Different Diagnostic Criteria, Different Treatment Methods And Glucose Metabolism Status Of Insulinoma

Objective: Comparison and significance of different diagnostic criteria,different treatment methods and glucose metabolism status of insulinoma.Methods: The clinical data of 75 patients with insulinoma confirmed by pathology after surgery or endoscopic ultrasonography admitted to the first affiliated hospital of guangxi medical university from January 2004 to February2019 were retrospectively analyzed,and the sensitivity and specificity of different diagnostic criteria were calculated.To analyze the postoperative complications of different treatment methods for insulinoma and the follow-up of blood glucose after treatment.Clinical data of insulinoma with abnormal glucose metabolism were analyzed.Results:1.75 cases of tumor patients with insulin in the 2014 edition of diagnosis and treatment of pancreatic neuroendocrine tumor expert consensus,2016 China gastrointestinal pancreatic neuroendocrine tumor expert consensus,2019 NCCN guidelines for neuroendocrine and adrenal tumors(the national cancer network),ninth edition,internal medicine diagnostic criteria sensitivity of insulin tumor were 58.7%,65.3%,92.0% and 92.0% respectively(P < 0.05),specificity were 96.9%,95.4%,90.8% and 89.9% respectively(P > 0.05).2.Among the 75 patients with insulinoma,39 received surgical treatment,15 had complications(accounting for 38.5%),38 had normal postoperative follow-up(accounting for 97%),10 had high blood glucose during hospitalization,and only 1(3%)had high blood glucose during postoperative follow-up.Among the36 patients who received endoscopic sclerosing agent injection,3(8.3%)developed complications,35(97%)had normal blood glucose and 1(3%)had hypoglycemia during postoperative follow-up,and Seventeen patients(47%)required multiple endoscopic ultrasonography with fine needle injection.3.Among the 75 patients with insulinoma,68 were in the group with normal glucose metabolism.There were 7 cases(9.3%)in the abnormal glucose metabolism group,among which 2 cases were type 2 diabetes mellitus and 5cases were abnormal glucose tolerance).The average age of onset was 47.3±14.3 years and 53.3 ±13.3 years,respectively,and the difference was not statistically significant(P=0.294>0.05).There were no statistically significant differences in BMI,course of disease,homr-ir,fasting glucose,synchronous c-peptide,and synchronous insulin between the two groups.The family history of diabetes in the abnormal glucose metabolism group(43%)was significantly different from that in the normal glucose metabolism group(5%)(P<0.05).4.Among the 7 patients with abnormal glucose metabolism,2 were diagnosed as type 2 diabetes mellitus,1 was treated with insulin and had good blood glucose control,while the other one was treated with diet and exercise and had poor blood glucose control.One of the 5 IGT patients lost follow-up,and the other 4returned to normal blood glucose.Conclusions: 1.The sensitivity and specificity of the 2019 NCCN guidelines for neuroendocrine and adrenal tumors or the 9th edition of theinternal medicine diagnosis are both high,and it is recommended to use the2019 NCCN oncology clinical practice guide or the 9th edition of the internal medicine insulinoma diagnosis standard to reduce missed diagnosis and misdiagnosis.2.There was no significant difference in blood glucose recovery between endoscopic ultrasonography and surgical treatment for insulinoma,Endoscopic ultrasonography has fewer complications and less trauma.About47% of insulinoma patients need multiple endoscopic sclerotherapy,which may be related to the size and number of tumors treated.3.The proportion of insulinoma with abnormal glucose metabolism was up to 9.3%,and most patients could return to normal after postoperative follow-up..