Grant C S, van Heerden J, Charboneau J W, James E M, Reading C C
Department of Surgery, Mayo Clinic, Rochester, MN 55905.
Arch Surg. 1988 Jul;123(7):843-8. doi: 10.1001/archsurg.1988.01400310057009.
After establishing the diagnosis of an insulinoma, most surgeons prefer preoperative localization. Selective arteriography has long remained the gold standard for this purpose, but its use has been met with variable success. Despite various attempts at localization, insulinomas remain undetected in 10% to 20% of patients, and there may be a postoperative complication rate of at least 10% to 25%. To review the results and surgical implications of current localization techniques, 36 adult patients who were surgically treated for insulinomas at the Mayo Clinic, Rochester, Minn, from July 1982 through June 1987 were studied. The sensitivities of tumor localization using arteriography, computed tomography, and preoperative and intraoperative ultrasonography were 53%, 36%, 59%, and 90%, respectively. A subset of 29 patients underwent intraoperative ultrasonography, and all of these patients' insulinomas were identified with a combination of this technique and intraoperative palpation, with nonpalpable tumors being imaged in four patients. In 18 patients (62%), information obtained from the images appeared to influence the surgical management. While there is no substitute for exploration by an experienced surgeon, exploration appears to be enhanced by the addition of intraoperative ultrasonography, particularly during reoperation.
在确诊胰岛素瘤后，大多数外科医生倾向于进行术前定位。长期以来，选择性动脉造影一直是实现这一目的的金标准，但使用效果不一。尽管进行了各种定位尝试，仍有10%至20%的患者未检测到胰岛素瘤，且术后并发症发生率可能至少为10%至25%。为了回顾当前定位技术的结果及手术意义，我们研究了1982年7月至1987年6月在明尼苏达州罗切斯特市梅奥诊所接受胰岛素瘤手术治疗的36例成年患者。使用动脉造影、计算机断层扫描、术前及术中超声进行肿瘤定位的敏感度分别为53%、36%、59%和90%。29例患者接受了术中超声检查，所有这些患者的胰岛素瘤均通过该技术与术中触诊相结合得以识别，其中4例不可触及的肿瘤被成像。在18例患者（62%）中，从图像中获得的信息似乎影响了手术管理。虽然经验丰富的外科医生进行探查无可替代，但术中超声检查的加入似乎增强了探查效果，尤其是在再次手术时。
