Abstract:Objective To summarize the experience in the diagnosis and treatment of insulinoma.Methods A retrospective study was performed on the clinical data of 33 cases of insulinoma who received treatment at Heze Municipal Hospital from January 2014 to December 2019,focused on the clinical manifestations,laboratory and imaging examination and treatment methods to explore its clinical characteristics of diagnosis and treatment.Results Thirty-one patients (93.9%) had typical Whipple′s triad.There were 23 patients had sympathetic excitation symptoms and 10 patients had nervous system dysfunction.Coma and syncope were the most frequent symptoms (23/33,69.7%).The positioning accuracy rates of preoperative ultrasound,gemstone spectral CT,enhanced CT,MRI,endoscopic ultrasound (EUS) and intraoperative ultrasound were 30.3% (10/33),70.4% (19/27),93.4% (28/30),66.7% (8/12),37.5% (3/8) and 100% (7 /7),respectively.There were 8 cases treated with resection of the pancreatic body and tail,including 4 cases combined with splenectomy,20 cases treated with resection of insulinoma,3 cases with simple distal pancreatectomy,1 case with pancreatoduodenectomy and 1 case with duodenum-preserving pancreatic head resection.Of 35 resected tumors,there were 28 solitary benign insulinomas,4 benign insulinomas (2 insulinomas in 2 patients) and 3 solitary malignant insulinomas.The blood glucose of all patients returned to the normal after surgery.After operation,one patient died of hepatic failure due to malignant insulinoma,and three patients presented with neuropsychiatric symptom (such as mental retardation,disorientation and memory decline) for a long time.Pancreatic leakage occurred in one patient after pancreatoduodenectomy.One patient was complicated with subphrenic infection,pleural effusion and pulmonary infection after resection of pancreatic body and tail combined with splenectomy.No complication occurred in other patients.conclusions Whipple′s triad is of great significance in the qualitative diagnosis of insulinoma.Radioimmunoassay of serum insulin and starvation test are helpful for supplementary diagnosis and differential diagnosis.Thin layer three-phase enhanced CT scan is the first choice for preoperative localization of insulinoma.MRI of pancreas is an important noninvasive supplementary examination method.Surgical resection is the best choice for the treatment of insulinoma.