Clinical Analysis Of 89 Cases Of Islet Cell Tumor

Objective:To evaluate clinical features,glucose metabolic profile,tumor distribution and its biological behavior in patients with islet cell tumor(ICT).To explore the strategy of the qualitative diagnosis and localization diagnosis,and the choice of treatment scheme in patients with islet cell tumor,in order to provide experience for the diagnosis and treatment of islet cell tumor for clinicians.Methods:The clinical data of 89 patients with islet cell tumor admitted to the Provincial Hospital affiliated to Shandong University from July 2006 to October 2017 were collected.All subjects were divided into two groups,including 68 cases of insulinoma and 21 cases of nonfunctional islet cell tumor.The retrospective analysis was carried out to analyze the clinical data of the two groups,including epidemiological data,clinical manifestation,laboratory examination,imaging examination,selection of surgical procedures,postoperative complications,tumor occupying features,biological behavior and so on.Results:1.Clinical features:(1)The clinical manifestations of insulinoma are complex and varied.The symptoms of central nervous system inhibition and sympathetic nerve excitability are the main manifestations.Some patients may have postprandial hypoglycemia.Some patients had been misdiagnosed as epileptic seizures or depression due to varying degrees of neuropsychiatric symptoms.(2)The early symptoms of nonfunctional islet cell tumor are often atypical,and many of them develop the symptoms of tumor compression at the late stage.2.Laboratory examination:In the insulinoma group,the fasting blood glucose was significantly lower than that of the nonfunctional islet cell tumor group,and 58.82%of patients with insulinoma have the fasting blood glucose levels lower than 2.8mmol/L;73.47%of the patients had the insulin releasing index larger than 0.3,and 87.76%had the insulin releasing correction index larger than 50,which suggested the diagnosis of insulinoma.In the OGTT test,46.87%showed impaired glucose tolerance,and the curve of insulin release curve indicated inappropriate insulin secretion.3.Imaging examination:Different examination methods showed significant difference in the location diagnosis of islet cell tumor.There was no significant difference between occupying diameter in various imaging examinations and occupying diameters in pathological reports.After comparing the insulinoma group and the nonfunctional islet cell tumor group,we found that CT was relatively close to the pathological diameter on the sections of each diameter distribution,while MRI was more sensitive to the smaller diameter occupying sites,and the ultrasound was less sensitive to the space occupying space than the diameter less than 1cm.4.Surgical procedures:The operation methods of islet cell tumor are mainly divided into simple tumor removal and local resection of the pancreas.The two types of operation have significant difference in the average age of the population,the diameter of the occupying position,and the risk assessment and class:ification of the operation.Among all the complications,the incidence of pancreatic fistula was the highest.In the insulinoma group,43 cases were treated with simple tumor removal,and the remaining 25 cases underwent local resection of the pancreas;only 3 cases in the nonfunctional islet cell tumor group were treated with simple tumor removal,and the other 18 cases underwent local resection of the pancreas.By monitoring the levels of blood glucose in the operation,it was found that the levels of blood glucose continued to rise and the difference was obvious after the lump resection.The levels of fasting blood glucose in some patients increased within about 3 to 5 days after operation,then gradually decreased.5.Tumor status:Compared with the tumor characteristics of insulinoma and nonfunctional islet cell tumor,there was a significant difference in the histological grade,biological characteristics and operation methods of the two groups.Conclusions:1.The clinical manifestations of insulinoma are complex and varied.The symptoms of central nervous system inhibition and sympathetic nerve excitation are the main manifestations.Patients with postprandial hypoglycemia or neuropsychiatric symptoms need to be highly vigilant for the possibility of insulinoma.The nonfunctional islet cell tumor always lacks typical clinical presentation,and the misdiagnosis is not uncommon.2.Fasting plasma glucose was significantly decreased in patients with insulinoma.Insulin release index and insulin release correction index is of great importance for the qualitative diagnosis of insulinoma.3.As a first-line examination method for the location diagnosis of islet cell tumor,CT has a higher diagnostic rate,while MRI has a higher sensitivity to tumors with small diameter.Intraoperative ultrasound is also an effective method for location diagnosis of islet cell tumor.4.Local resection of tumor is the most common operation method of nonfunctional islet cell tumor,but simple tumor removal shows more advantages in patients with insulinoma,including less operation risk,less bleeding in operation,short operation time,low postoperative complication rate and short postoperative hospital time.Blood glucose monitoring has certain significance for determining whether there is tumor residual during operation.5.Compared with insulinoma,nonfunctional islet cell tumor tends to be more malignant in clinical pathology and biological behavior.