超声内镜引导下无水乙醇注射法与外科手术法治疗良性胰岛素瘤的对比研究*

摘要： 目的??评估超声内镜（EUS）引导下无水乙醇注射法治疗良性胰岛素瘤的疗效与安全性，并与外科手术治疗法相比较。方法?回顾性分析2011年4月-2016年2月在广西医科大学第一附属医院经EUS引导下无水乙醇注射法治疗或外科手术法治疗的38例良性胰岛素瘤临床资料。结果?97.4%（37/38）的患者有典型的Whipple三联征，82.9%（29/35）患者低血糖发作时胰岛素释放指数（I/G）>0.3。术前B超、CT、磁共振成像（MRI）、正电子发射计算机断层显像（PET/CT）和EUS定位诊断胰岛素瘤阳性率分别为50.0%、67.6%、66.7%、75.0%和89.7%。18例行EUS引导下无水乙醇注射治疗（EUS-FNI组），20例行外科手术治疗（外科手术组），EUS-FNI组术后均无并发症发生，外科手术组中40.0%（8/20）患者出现并发症。与外科手术组相比，EUS-FNI组在手术时间、术中出血、术后并发症、术后住院时间和住院总费用上均明显降低（P <0.05）。所有患者均得到随访，EUS-FNI组最后一次无水乙醇注射治疗后所有患者血糖平稳在正常范围；外科手术组20例患者中，90.0%（18/20）患者术后无低血糖症状再发作，监测血糖在正常范围，10.0%（2/20）患者术后低血糖症状发作较术前减少。结论?EUS引导下无水乙醇注射法治疗良性胰岛素瘤安全、有效。与外科手术法相比，具有微创、经济、并发症少和术后恢复快等优势。
Abstract: Objective?To evaluate the safety and efficacy of endoscopic ultrasound (EUS) guided ethanol ablation of benign insulinoma and compare its’ advantages and disadvantages with surgical treatment.?Methods?From April 2011 to February 2016, clinical data of 38 patients with benign insulinoma treated by EUS-guided ethanol ablation or surgical treatment were retrospectively analyzed.?Results?97.4% (37/38) patients had a typical clinical manifestation of Whipple’s triad, and the I/G ratio of 82.9% patients (29/35) was more than 0.3 with their onset of hypoglycemia. The positive preoperative etiologic diagnosis rates of transabdominal ultrasonography, CT, MRI, PET/CT and EUS were 50.0%, 67.6%, 66.7%, 75.0%, 89.7% respectively. In the current study, 18 patients underwent EUS-guided ethanol ablation (EUS-FNI group) and 20 patients received surgical treatment (surgical group). Compared with the surgical group, the operation time, intraoperative hemorrhage volume, postoperative complications, length of stay and hospitalization costs were significantly reduced in the EUS-FNI group (P < 0.05). No treatment-related complications was observed in EUS-FNI group, while 40.0% (8/20) patients in surgical group had complications. During the follow-up period, all these patients maintained stable blood glucose without taking medication, and there’s no recurrence of insulinoma in EUS-FNI group after the last treatment with alcohol injection; In surgical group, only 90.0% (18/20) patients had no recurrence, episode of hypoglycemia was less after the operation in 10.0% (2/20) patients.?Conclusion?EUS-guided ethanol ablation of benign insulinoma is safe and effective, compared with traditional surgical treatment, EUS-guided ethanol ablation is minimally invasive, costs less, recovers fast after treatment and has fewer complications.