动脉钙剂刺激检查术前定位胰岛素瘤临床价值的探讨
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摘要
目的:探讨经动脉钙剂刺激肝静脉采血(ASVS)检查术前定位胰岛素瘤的临床价值。方法:对8例临床定性诊断为胰岛素瘤的患者术前行ASVS检查,选择性插管至肝固有动脉(PHA)、胃十二指肠动脉(GDA)、肠系膜上动脉(SMA)、脾动脉近段(SAP)和脾动脉远段(SAD),分别快速注入10%的葡萄糖酸钙进行激发,于激发前和激发后30、60、90、120和180s经肝静脉采血2ml测血胰岛素值,不同动脉激发试验的间隔时间至少为15分钟。计算不同动脉激发值与基础值之比值,若胰岛素峰值达到或超过基础值的4倍以上,即提示该动脉为肿瘤的供血动脉,肿瘤即被定位于相应的胰腺区域。若两支以上动脉内激发的胰岛素峰值大于等于4倍基础胰岛素水平,将比值最高者的动脉所供应的胰腺区域认定为肿瘤所在区域。结果:8例患者在行ASVS操作过程中无明显的不良反应,检查后无并发症产生。其中在本院行手术治疗并经病理证实为胰岛素瘤的有6例,2例失访,6例手术患者术后证实均为孤立性胰岛素瘤,病灶大小为0.7～1.6cm,6例中有5例ASVS结果与最终诊断完全一致,ASVS定位准确性为83.3%,优于经腹超声(16.7%)、CT(33.3%)、MRI(50%)。结论: ASVS在胰岛素瘤术前定位中准确性高而且安全,尤其适合于其他影像学检查阴性或不同检查方法诊断有出入的隐匿型胰岛素瘤。
Objective : To evaluate the clinical value of intra-arterial calcium stimulation and venous sampling (ASVS) for localization of insulinoma preoperatively. Methods: Eight patients with clinically proved insulinoma underwent ASVS test ,proper hepatic artery(PHA)、gastroduodenal artery(GDA)、superior mensenteric artery(SMA)、proximal and distal splenic arteries(SAP and SAD) were selectively catheterized for stimulation by rapid injection of calcium gluconate. Blood was sampled through hepatic vein before and 30, 60, 90, 120, 180 s after stimulation for gauging the insulin levels.A gap of 15 minutes between every two stimulations was preserved.The tumor would be regionalized in the corresponding area if the peak value of insulin after stimulations in certain artery reached or higher than 4 times of the baseline level.If two or above arteries reached or higher than 4 times of the baseline level, The tumor site was considered to be at the corresponding area supplied with certain artery stimulated showing the peak ratio of insulin to the baseline. Results: Eight patients didn’t have adverse reactions during ASVS and applications after ASVS.Six solitary insulinomas with the size as 0.7-1.6cm were diagnosed after surgery,two patients were lost.The results of ASVS were identical to the final diagnosis in 5 cases,the accuracy of ASVS was 83.3%, demonstrating the superiority over BUS( 33.3%) , CT( 75%) , MRI( 80%) .Conclusion: ASVS is an accurate and safe technique to localize insulinomas preoperatively, especially for occult insulinomas with negative or discrepancy findings in imaging studies.
Objective : To evaluate the clinical value of intra-arterial calcium stimulation and venous sampling (ASVS) for localization of insulinoma preoperatively. Methods: Eight patients with clinically proved insulinoma underwent ASVS test ,proper hepatic artery(PHA)、gastroduodenal artery(GDA)、superior mensenteric artery(SMA)、proximal and distal splenic arteries(SAP and SAD) were selectively catheterized for stimulation by rapid injection of calcium gluconate. Blood was sampled through hepatic vein before and 30, 60, 90, 120, 180 s after stimulation for gauging the insulin levels.A gap of 15 minutes between every two stimulations was preserved.The tumor would be regionalized in the corresponding area if the peak value of insulin after stimulations in certain artery reached or higher than 4 times of the baseline level.If two or above arteries reached or higher than 4 times of the baseline level, The tumor site was considered to be at the corresponding area supplied with certain artery stimulated showing the peak ratio of insulin to the baseline. Results: Eight patients didn’t have adverse reactions during ASVS and applications after ASVS.Six solitary insulinomas with the size as 0.7-1.6cm were diagnosed after surgery,two patients were lost.The results of ASVS were identical to the final diagnosis in 5 cases,the accuracy of ASVS was 83.3%, demonstrating the superiority over BUS( 33.3%) , CT( 75%) , MRI( 80%) .Conclusion: ASVS is an accurate and safe technique to localize insulinomas preoperatively, especially for occult insulinomas with negative or discrepancy findings in imaging studies.
引文
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[6]马钢,郭克建,田雨霖等.胰岛素瘤的诊断和治疗:附137例报告[J].中国普通外科杂志,2007 ,16 (10) :943-944。
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[15]冯留顺,李旭辉,李捷等.胰岛素瘤的诊断和治疗[J].中国普通外科杂志,2007,16(5):480-482.
[16]赵玉沛,从林,张太平等.胰岛素瘤404例诊治分析[J].中国实用外科杂志,2008, 28 (5) : 357.
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[18] Gourgiotis S, Moustafellos P , Zavos A , et al. Localisation and surgical treatment of insulinomas [J] .Int J Clin Pract ,2007,61 (4):558-561.
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[20] D ' Onofrio M,Mansueto G,Vasori S,et al.Contrast-enhanced ultrasonogarphic detection of small pancreatic insulinom[J].JUltrasoud,Med,2003,22(4):413-417.
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