Lo C Y, Chan F L, Tam S C, Cheng P W, Fan S T, Lam K S
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.
Surgery. 2000 Dec;128(6):903-9. doi: 10.1067/msy.2000.109729.
Intra-arterial calcium stimulation with hepatic venous sampling (ASVS) for insulin gradients has been reported to be the most sensitive preoperative localizing technique for insulinomas. We reviewed our experience with ASVS to localize and guide the treatment of insulinomas over the past decade.
Eighteen patients who underwent ASVS before surgical exploration for insulinoma were studied. The accuracy of ASVS was compared with intraoperative findings and other localizing studies.
There were no complications arising from the procedures. A more than 2-fold step-up in insulin level 30 to 60 seconds after injection to at least 1 feeding artery was observed in 16 patients. Fourteen of the 16 solitary tumors (87.5%) were correctly located; 100% (6/6 tumors) at the head and 80% (8/10 tumors) at the body/tail. The overall accuracy of this test was 89%, compared with 11%, 33%, 38%, and 63% of ultrasonography, computed tomography, magnetic resonance imaging, and endoscopic ultrasonography, respectively. Six enucleations and 10 distal resections were performed, which included 2 laparoscopic procedures. The combination of intraoperative ultrasonography with preoperative ASVS identified all tumors.
ASVS is the most accurate preoperative localization tool for the localization of insulinomas and, in combination with intraoperative ultrasonography, can enhance surgical success.
据报道，肝静脉采血的动脉内钙刺激试验（ASVS）用于检测胰岛素梯度，是胰岛素瘤术前最敏感的定位技术。我们回顾了过去十年间我们使用ASVS定位和指导胰岛素瘤治疗的经验。
对18例在手术探查胰岛素瘤前行ASVS的患者进行研究。将ASVS的准确性与术中发现及其他定位研究进行比较。
该操作未引起并发症。16例患者在注射后30至60秒时，至少有1条供血动脉的胰岛素水平升高超过2倍。16个孤立肿瘤中的14个（87.5%）定位正确；其中6个位于胰头的肿瘤定位正确率为100%，10个位于胰体/胰尾的肿瘤定位正确率为80%。该检查的总体准确率为89%，而超声、计算机断层扫描、磁共振成像和内镜超声的准确率分别为11%、33%、38%和63%。共进行了6次肿瘤剜除术和10次远端切除术，其中包括2例腹腔镜手术。术中超声与术前ASVS相结合可识别所有肿瘤。
ASVS是胰岛素瘤术前最准确的定位工具，与术中超声相结合可提高手术成功率。
