Diagnosis and management of insulinoma:a report of 72 cases

Objective: To investigate the diagnosis and surgical treatment of insulinoma. Methods: The clinical data of 72 patients with insulinoma admitted to our hospital spanning more than 31 years were retrospectively analyzed. Results: Of the 72 patients,84.72% had a typical Whipple's triad,and the ratio of plasma immunoreactive insulin to glucose(IRI/G) was greater than 0.3 in 80.56%.The positive rates of preoperative niveau diagnosis were 78.13% by transabdominal ultrasonography,60.97% by CT,100% by pancreatic perfusion imaging of multislice spiral CT,37.50% by MRI,72.73% by endoscopic ultrasound and 28.57% by DSA,respectively.The diagnostic positive detection rate of intraoperative ultrasonography(IOUS) plus palpation was 92.31%.The diameters of 88.75% of the tumors were less than 2 cm,and 37.5% of tumors were located in the head and neck of the pancreas,27.5% in the body,and 35.0% in the tail,and 81.58% of the patients had indications for regional enucleation of insulinoma.All of the 72 cases were confirmed as insulinoma by final pathology,of whom 65(90.28%) were functional insulinoma,7(9.72%) were nonfunctional insulinoma,4(5.56%) were multiple insulinoma,2(2.78%) had malignant tendency,and 1(1.39%) was combined with multiple endocrine neoplasia type 1(MEN-1). Conclusion: Whipple's triad and IRI/G0.3 can be the main basis for the defining diagnosis of insulinoma.A combination of multiple examinations such as ultrasonography,CT,pancreatic perfusion imaging of multislice spiral CT,MRI,endoscopic ultrasound and DSA may be recommended before operation,and IOUS plus palpation is a simple and effective way for intraoperative localization.Regional enucleation of insulinoma is the best surgical approach for most insulinoma.