Analysis Of 23 Insulinoma Cases And 12 Nonfunctional Islet Cell Tumor Cases

Objective:To discuss the preoperative qualitation and localization, operational options,the prognosis of insulinoma and nonfunctional islet cell tumor(NIT).Methods:A retrospective analysis was performed for 23 cases of insulinoma and 12 cases of NIT,who received treatment from 1994.1 to 2007.1 in Xiangya Hospital,Central South University.Results:35 patients were pathologic diagnosed,23 patients suffered insulinoma for 32.2 months whose average age was 40.0 years old,12 patients suffered NIT for 12.5 months whose average age was 40.7 years old.The preoperative localization accuracy of B-ultrasonography(B-us) and computed tomography(CT)was 50%and 76.1%respectively in insulinoma,90%and 100%respectively in NIT.There was a significant difference between B-us and CT examinations for insulinoma cases (p＜0.01),while the difference between B-us and CT examinations in the cases of NIT was not significant(p=0.476).All 35 patients underwent operation treatment.In the group of insulinoma with 22 benign cases and one malignant case,the mass was located in the head of pancreas for 10 cases and in the body/tail of pancreas for 13 cases.The operational option adopted simple enucleation or partial pancreas resection in 15 patients, distal pancreatectomy combined with splenectomy in seven patients in the benign cases,pancreatic cyst stripping combined with liver metastasis stove alcohol injection in the malignant case.Intraoperative B-us(IOUS) examination was performed in six cases.In the group of NIT with eight benign cases and four malignant cases.The benign mass was located in the head of pancreas for six cases and in the body/tail of pancreas for two cases.The operational treatment adopted simple enucleation or partial pancreas resection in two patients,distal pancreatectomy combined with splenectomy in two patients,pancreaticoduodenectomy in three cases, and partial pancreatectomy combined with pancreaticojejunostomy in one case.The malignant mass was located in the head of pancreas for two cases and in the body/tail of pancreas for two subjects.The operation adopted distal pancreatectomy in one case,pancreaticoduodenectomy in two cases,and colon metastasis biopsy in one case.For the patients of insulinoma,there was a significant difference between the preoperative blood sugar of 1.70±0.71mmol/L and that of 5.83±1.87mmol/L 30 minutes post tumor resection(p＜0.01).An average of 6.4 days was needed for blood sugar to recover to normal level.23 cases were followed up,the follow-up rate was 65.7%.15 benign insulinoma followed up 3-123 months,who survived for 14 cases and died with other disease for one case.One malignant insulinoma had a 24-month follow-up,who still had low blood sugar symptoms and no unconsciousness.Five benign NIT followed up 12-100 months.no longer appearing abdominal pain and abdominal mass.Two malignant NIT had a 12-month and 24-month follow-up respectively,who still survived.Conclusions:B-us and CT should be the routine preoperational imaging examination.CT of insulinoma has a higher diagnostic rate than that of B-us.Exploration and IOUS are the best ways of localization. Blood sugar monitoring intraoperatively is useful for judging whether the tumor is resected or not.Operation has good effect.Choose the best operative style by the conditions intraoperatively.