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目的分析1985年以来不同阶段各项影像学方法对胰岛素瘤术前定位诊断的价值。方法回顾性分析1985年1月到2008年4月就诊于解放军总医院内分泌科并行手术病理确诊的100例胰岛素瘤患者的临床资料,时间划分以引入新的影像学方法为准。结果所有患者均有典型的Whipple三联征表现,病程3周至25年。95例患者住院期间监测到的最低血糖波动在0.3～2.5 mmol/L之间。其中91例血浆胰岛素/血糖(INS/G)>0.3。各项术前定位影像方法的阳性率如下:1985—1999年,B超5.3%(1/19),胰腺CT 31.6%(6/19),胰腺MRI 0(0/2),胰腺血管造影DSA 50.0%(5/10)。2000—2006年,B超24.1%(7/29),胰腺CT 52.6%(20/38),胰腺MRI 40.0%(2/5),胰腺血管造影DSA 84.6%(22/26),内镜下超声EUS 100.0%(24/24)。2007年至2008年4月,B超32.0%(8/25),胰腺CT61.5%(16/26),胰腺MRI 87.5%(7/8),胰腺血管造影DSA 76.9%(20/26),内镜下超声EUS 94.7%(18/19),超声造影UC 94.4%(17/18)。结论各项影像定位检查价值差异很大,自1985年以来,超声、CT、MRI及DSA定位诊断阳性率逐渐提高,自2000年,EUS以最高的定位阳性率被认可,广泛应用。2008年,超声造影被尝试用于胰岛素瘤的定位,价值潜力很大。术前定位诊断方法多元化、简单化,术前定位价值逐渐提高。
Objective To analyze the value of various imaging methods in the diagnosis of insulinoma preoperatively since 1985. Methods The clinical data of 100 cases of insulinoma diagnosed concurrently with Pathology in Department of Endocrinology of Chinese PLA General Hospital from January 1985 to April 2008 were retrospectively analyzed. The classification of time was based on the introduction of new imaging method. Results All patients had typical Whipple triad manifestations, duration of 3 weeks to 25 years. The lowest blood glucose level monitored during hospitalization in 95 patients ranged from 0.3 to 2.5 mmol / L. 91 cases of plasma insulin / blood glucose (INS / G)> 0.3. The positive rates of each preoperative imaging method were as follows: from 1985 to 1999, B-ultrasound was 5.3% (1/19), pancreatic CT was 31.6% (6/19), pancreas MRI was 0 (0/2) and pancreatic angiography was performed on DSA 50.0% (5/10). From 2000 to 2006, 24.1% (7/29) of B ultrasound, 52.6% (20/38) of pancreas CT, 40.0% (2/5) of pancreas MRI, and 84.6% (DSA) of pancreas angiography DSA Ultrasound EUS 100.0% (24/24). From 2007 to April 2008, 32.0% (8/25) of B ultrasound, 61.5% (16/26) of pancreatic CT, 87.5% (7/8) of pancreatic MRI and 76.9% (20/26) of pancreatic angiography DSA , Endoscopic ultrasound EUS 94.7% (18/19), ultrasound contrast UC 94.4% (17/18). CONCLUSIONS: There are great differences in the value of image localization examination. Since 1985, the positive rate of ultrasound, CT, MRI and DSA localization has been gradually increasing. Since 2000, EUS has been widely used as the highest positive localization rate. In 2008, CEUS was attempted for the localization of insulinomas, with great potential value. Preoperative localization of diagnostic methods of diversification, simplification, preoperative positioning value gradually increased.