中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2011年
5期
406-409
,共4页
胰岛素瘤%放射学,介入性%诊断技术%内分泌
胰島素瘤%放射學,介入性%診斷技術%內分泌
이도소류%방사학,개입성%진단기술%내분비
Insulinoma%Radiology,interventional%Diagnostic techniques,endocrine
目的 探讨选择性动脉钙刺激后肝静脉血清胰岛素测定(ASVS)术前定位胰岛素瘤的临床应用价值.方法 对2000年5月至2010年6月收治的28例术前行ASVS检查的胰岛素瘤患者的病史资料进行回顾性分析.结果 28例患者中男12例,女16例,均有Whipple三联征表现.手术切除瘤体32枚,78.1%瘤体直径＜20 mm;术后病理均证实为胰岛素瘤,其中26例单发,2例多发.ASVS检查6例肠系膜上动脉出现最高峰值比,9例胃十二指肠动脉出现最高峰值比,6例脾动脉近段出现最高峰值比,6例脾动脉远段出现最高峰值比,1例检查结果阴性.ASVS最高峰比值数值的中位数、平均数分别为8.8倍、14.8倍.ASVS正确定位25例,错误定位2例,1例检查结果阴性,ASVS准确率为89.3%(25/28),高于同组CT、MRI(CT、MRI定位准确率分别为56.5%,60.0%);ASVS敏感度为96.2%,高于同组CT、MRI(CT、MRI敏感度分别为69.6%,75.0%).结论 ASVS术前定位胰岛素瘤较CT、MRI有优势,但ASVS创伤大,应作为CT、MRI等常规影像学检查阴性时定位胰岛素瘤的补充定位手段.
目的 探討選擇性動脈鈣刺激後肝靜脈血清胰島素測定(ASVS)術前定位胰島素瘤的臨床應用價值.方法 對2000年5月至2010年6月收治的28例術前行ASVS檢查的胰島素瘤患者的病史資料進行迴顧性分析.結果 28例患者中男12例,女16例,均有Whipple三聯徵錶現.手術切除瘤體32枚,78.1%瘤體直徑＜20 mm;術後病理均證實為胰島素瘤,其中26例單髮,2例多髮.ASVS檢查6例腸繫膜上動脈齣現最高峰值比,9例胃十二指腸動脈齣現最高峰值比,6例脾動脈近段齣現最高峰值比,6例脾動脈遠段齣現最高峰值比,1例檢查結果陰性.ASVS最高峰比值數值的中位數、平均數分彆為8.8倍、14.8倍.ASVS正確定位25例,錯誤定位2例,1例檢查結果陰性,ASVS準確率為89.3%(25/28),高于同組CT、MRI(CT、MRI定位準確率分彆為56.5%,60.0%);ASVS敏感度為96.2%,高于同組CT、MRI(CT、MRI敏感度分彆為69.6%,75.0%).結論 ASVS術前定位胰島素瘤較CT、MRI有優勢,但ASVS創傷大,應作為CT、MRI等常規影像學檢查陰性時定位胰島素瘤的補充定位手段.
목적 탐토선택성동맥개자격후간정맥혈청이도소측정(ASVS)술전정위이도소류적림상응용개치.방법 대2000년5월지2010년6월수치적28례술전행ASVS검사적이도소류환자적병사자료진행회고성분석.결과 28례환자중남12례,녀16례,균유Whipple삼련정표현.수술절제류체32매,78.1%류체직경＜20 mm;술후병리균증실위이도소류,기중26례단발,2례다발.ASVS검사6례장계막상동맥출현최고봉치비,9례위십이지장동맥출현최고봉치비,6례비동맥근단출현최고봉치비,6례비동맥원단출현최고봉치비,1례검사결과음성.ASVS최고봉비치수치적중위수、평균수분별위8.8배、14.8배.ASVS정학정위25례,착오정위2례,1례검사결과음성,ASVS준학솔위89.3%(25/28),고우동조CT、MRI(CT、MRI정위준학솔분별위56.5%,60.0%);ASVS민감도위96.2%,고우동조CT、MRI(CT、MRI민감도분별위69.6%,75.0%).결론 ASVS술전정위이도소류교CT、MRI유우세,단ASVS창상대,응작위CT、MRI등상규영상학검사음성시정위이도소류적보충정위수단.
Objective To evaluate the clinical value of selective intra-arterial calcium stimulated venous sampling ( ASVS) for the localization of pancreatic insulinoma preoperatively.Methods The clinical data of 28 insulinoma patients admitted from May 2000 to June 2010 in Ruijin Hospital undergoing selective intra-arterial calcium stimulated venous sampling with diagnosis of insulinomas before surgery were analyzed retrospectively.Results There were 12 males and 16 females.All the patients had Whipple's triad, and with proved insulinomas by postoperative pathology.There were 26 cases of single insulinoma and 2 cases of multiple insulinomas with altogether 32 insulinomas resected.78.1% of insulinomas were less than 20 mm.All patient were examined by selective intra-arterial calcium stimulated venous sampling.The peak ratio of insulin to the baseline after calcium stimulation appeared at the superior mensenteric artery (SMA) in 6 cases, and the peak ratio of insulin to the baseline after calcium stimulation appeared at gastroduodenal artery(GDA), proximal splenic artery (SAP) and distal splenic artery (SAD) in 9 cases, 6 cases and 6 cases respectively; Selective intra-arterial calcium stimulated venous sampling accurately located 25 cases, and selective intra-arterial calcium stimulated venous sampling located 2 cases wrongly.In one patient, the selective intra-arterial calcium stimulated venous sampling was falsely negative.The mean and median peak ratio of insulin to the baseline after calcium stimulation were 8.8 folds and 14.8 folds respectively.Accurate rate of selective intra-arterial calcium stimulated venous sampling was 89.3% (25/28) and it was higher than that of computed tomography (CT) (56.5% ) , magnetic resonance imaging (MRI) (60.0%).Sensitivity of selective intra-arterial calcium stimulated venous sampling was 96.2%, which was higher than that of computed tomography ( 69.6% ) , magnetic resonance imaging (75.0% ).Conclusion Selective intra-arterial calcium stimulated venous sampling is superior to computed tomography, or magnetic resonance imaging as a preoperative localizing tool for insulinomas, since this procedure is invasive it should be used when other preoperative morphologic studies (computed tomography or magnetic resonance imaging) failed.
