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（2010-07-13收稿）文章编号：1005-2208（2010）09-0751-04

胰岛素瘤定位及定性诊断

张太平，徐建威，赵玉沛

【摘要】胰岛素瘤是最常见的胰腺内分泌肿瘤，手术治疗

是惟一的根治性治疗手段。胰岛素瘤定性诊断主要依据Whipple三联征和血清胰岛素与血糖比值，必要时可进行72h饥饿试验；定位诊断首选无创伤性检查手段，北京协和医院采用改良多层螺旋CT胰腺双期增强扫描准确率可达95%以上，术中超声检查联合术中探查定位准确率最高，可达100%。数字减影血管造影（DSA）、经皮经肝门静脉采血测定胰岛素（PTPC）和选择性动脉钙刺激静脉采血测定胰岛素（ASVS）等有创检查已基本不用。

【关键词】胰岛素瘤；定位诊断；定性诊断

中图分类号：R6文献标志码：A

Actuality of diagnosis and localization of insulinoma ZHANG Tai-ping，XU Jian-wei，ZHAO Yu-pei.Department of Surgery,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science, Beijing100730,China

Corresponding author:ZHAO Yu-pei,E-mail:zhao8028@263. net

Abstract Insulinoma is one of the most common pancreatic endocrine tumors.Surgical treatment is the only curative method.Whipple triad and the ratio of insulin to glucose are the key points for diagnosis of insulinoma.We can do the process of72h fasting test if it is necessary.Non-invasive diagnostic methods are the first choice for localization of the tumors.In our hospital the improved MSCT has a high accuracy up to95.1%.Combination IOUS and exploration has the highest accuracy up to100%.Invasive diagnostic methods like DSA,PTPC and ASVS have seldom been used.This paper makes a evaluation and overview of the localization of insulinoma and is also as a reference for clinic work. Keywords insulinoma;localization;diagnosis

胰岛素瘤起源于胰腺的β细胞，是最常见的胰腺内分泌肿瘤，占胰腺内分泌肿瘤的25%，但仅有5%~11%是恶性肿瘤。大多数胰岛素瘤直径<2cm，其发生部位均匀分布于胰头（36.2%）、胰体（28.2%）、胰尾（35.6%）［1］。胰岛素瘤的临床表现复杂多样、容易误诊，但只要提高对本病的警惕性，了解低血糖发作的特点并辅以相应的实验室检查多可获得明确的定性诊断。胰岛素瘤有多种定位诊断方法，各种方法均有利弊，如何选择有效的诊断方法，优化诊断策略，是临床医生必须面临的问题。

本文对目前常用的胰岛素瘤诊断方法进行了综述和评价，以为临床工作提供参考。

1定性诊断

胰岛素瘤的诊断重点是定性诊断，需要将临床表现与实验室检查相结合。典型的Whipple三联征和低血糖时血清胰岛素/血糖（IRI/G）比值>0.3，是诊断胰岛素瘤的重要依

作者单位：中国医学科学院北京协和医院外科，北京100730通讯作者：赵玉沛，E-mail：zhao8028@