Eisold S, Schmidt J, Antolovic D, Leutloff U, Libicher M, Klar E
Chirurgische Universitätsklinik, Heidelberg.
Chirurg. 2000 Oct;71(10):1236-42. doi: 10.1007/s001040051209.
Approximately 10% of all insulinomas--the most common neuroendocrine pancreatic tumor--occur in multiple sites of the pancreas (e.g., multiple endocrine neoplasia type I) and rarely as islet cell hyperplasia. Malignant insulinomas appear in 10% to 15% of cases. For these special groups and for patients with a reoperation preoperative localization of the tumour is advisable. With current imaging technology, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, and somatostatin receptor scintigraphy (SRS), localization of insulinomas is often inadequate.
In this study we report our results using intra-arterial calcium-stimulated venous blood sampling (ASVS) to localize and guide the management of insulinomas for patients with a reoperation because of recurrent insulinomas or persistent hyperinsulinism, for patients with malignant neoplasm and for patients with a previous abdominal operation.
For all three cases the insulinomas were correctly localized by the ASVS in contrast to the preoperative imaging studies.
Our experience and a review of the current literature demonstrate that ASVS is a highly accurate (sensitivity > 90%) and a safe method for preoperative localization of insulinomas. For patients with a reoperation ASVS is recommended and the extensive use of other costly preoperative methods should be avoided.
在所有胰岛素瘤（最常见的胰腺神经内分泌肿瘤）中，约10%发生于胰腺的多个部位（如I型多发性内分泌腺瘤），极少为胰岛细胞增生。恶性胰岛素瘤见于10%至15%的病例。对于这些特殊群体以及需要再次手术的患者，术前对肿瘤进行定位是可取的。利用包括计算机断层扫描（CT）、磁共振成像（MRI）、超声检查和生长抑素受体闪烁显像（SRS）在内的当前成像技术，胰岛素瘤的定位常常不够准确。
在本研究中，我们报告了使用动脉内钙刺激静脉血采样（ASVS）对因复发性胰岛素瘤或持续性高胰岛素血症而再次手术的患者、患有恶性肿瘤的患者以及曾接受腹部手术的患者进行胰岛素瘤定位并指导其治疗的结果。
与术前影像学检查相比，所有三例患者的胰岛素瘤均通过ASVS正确定位。
我们的经验以及对当前文献的回顾表明，ASVS是一种高度准确（敏感性>90%）且安全的胰岛素瘤术前定位方法。对于需要再次手术的患者，建议采用ASVS，应避免广泛使用其他昂贵的术前方法。
