The Experience Of Diagnosis And Resection Of Functional Insulinoma (a Report Of 12 Cases)

Functional insulinoma is a rare tumor, but it is also the most common pancreatic endocrine tumors. A lot of insulin secretion would lead to recurrent hypoglycemia. Hypoglycemia symptoms have varied performance, and some doctors do not have sufficient knowledge about insulinoma, many of these patients were misdiagnosed as epilepsy, hysteria such as mental illness, lack of clear and timely treatment. Insulinoma can result low blood glucose, have smaller tumor size, appear in varied locations, and inappropriate operation will lead to a higher level trauma or serious postoperative complications, so in order to reduce perioperative complications, to determine whether the tumor was completely removed, reducing the trauma, preoperative preparation, intraope- rative positioning, select the appropriate operation and intra-operative blood glucose monitoring are the focus of the current study.This study summarized the progress of diagnosis and treatment of insulin- oma in recent years, recalls the clinical data of insulinoma patients in our hospital since 1996.To analyse the clinical manifestations of insulinoma, diagnostic value of attack or fasting blood glucose, insulin, C-peptide and IRI / G and the effect of positioning technology used in preoperative localization and intraoperative, and summarize the experience about insulinoma preoperative preparation, surgical treatment, intraoperative blood glucose monitoring and dealing with post-operative complications in our hospital, with a view to enhance the level of diagnosis and treatment of insulinoma.Objective: To discuss the functional insulinoma diagnosis and treatment, to enhance the understanding of the diagnosis and treatment.Methods: The clinical materials of 12 cases of insulinoma treated in Third Hospital of Jilin University between 1996 and 2009 were analysed retrosp- ectively.Results: 12 cases of functional insulinoma were collected, male3, female 9, male to female ratio was 1:3; they were 33-68 years old, and the median age was 52-year-old; the least time of course of disease is 2 months, the most time is 22 years, and the average is 81 months. 11 cases were benign tumors, one cases was suspected malignancy, no cases had distant metastasis; 11 cases were single tumors, one cases was multiple tumors (three, all located in pancreatic tail); 5 cases tumors were located in the head of the pancreas, 3 cases in the body, 4 cases in the tail, tumor diameter> 2.0cm 1 cases, 1cm-2cm10 cases, accounting for about 83%, <1cm 1 cases. 11 cases had the typical Whipple's triad symptoms, the longest patient history was 22 years. 9 cases went to hospital because of the heart palpitations, sweating, dizziness after hunger, one cases of which were treated in department of general surgery after endocrine treatment; 3 cases went to hospital because of recurrent coma, convulsions, 2 cases of which were treated in department of general surgery after the department of neurology treatment. The positive rates of biochemistry examinations were Glucose 92%, Insulin 89%, C-peptide 100%, IRI/G100%. The positive rates of examinations for localization before operation and in operation were Ultrasound 75%, CT 9%, Enhanced CT 36%, MRI0%, Meticulously palpating the gland83%, Intraoperative Ultrasound 100%. Monitoring blood glucose in the resection of insulinoma, 12 cases started to rise within 10-30 min clearly. The blood glucose of 10 cases increase 1 times within 60 min, 1 case increase 1.5 times within 90 min, and another case increase 1 times within 180 min. Enucleation of tumors was applied in 9 cases, 2 of them had pancreatic fistula after operation; excision of pancreatic tail was applied in 1 cases, and hadn't pancreatic fistula after operation, excision of tumors and some pancreatic tissue was applied in 2 cases, and one of them had pancreatic fistula after operation. All patients after resection of the tumor did not have hypoglycemia symptoms, and had the increase in blood glucose. 7 cases were followed up, five cases couldn't. All seven cases didn't have hypoglycemia symptoms again, one of which had high fasting blood glucose (>7.2mmol/L); 2 cases with postoperative followed-up in the 3 cases that had pancreatic fistula recovered and removed drainage tube in one year, another one case leaved hospital without drainage tube. Conclusions:The people who may be with insulinoma should not only be detected blood glucose and insulin, but also be detected C-peptide, IRI / G. The diagnosis method that combines meticulously palpating and IOUS in the intra-operative diagnosis is an effective means of tumor location. Monitoring blood glucose changes after tumor resection combined with intra-operative pathology can quickly determine whether the insulinoma is completely resected.