Rolny P, Järnerot G, Wickbom G, Widström A
Hepatogastroenterology. 1981 Oct;28(5):264-6.
ERCP was performed in three patients with insulinoma. One had a large malignant tumor, while the remaining two had small tumours. In two of these patients pancreatic juice was collected for C-peptide determination. Pancreatography was performed and pancreatic juice was obtained in seven other subjects comprising: five control subjects and two patients in whom insulinoma was suspected because of symptoms suggestive of hypoglycaemia. Pancreatography was normal in all subjects except the patient with a large insulinoma in whom an obstruction of the main pancreatic duct was found. The maximal C-peptide concentrations in pancreatic juice of patients with insulinoma were found to be several-fold higher than in the control subjects and in one of the patients in whom insulinoma was suspected but unproven. The remaining patient with suspected insulinoma had a maximal C-peptide concentration comparable with those found in patients with proven insulinoma. Thus remarkable differences in maximal C-peptide concentrations obtained in patients with and without insulinoma were found. However, the clinical significance of the findings needs further evaluation. The value of ERP in patients with suspected insulinoma may be twofold: an obstruction of the main pancreatic duct may indicate a large, hardly resectable tumour; in patients in whom the duct is unaffected the relation between the tumour as visualized by angiography, and the duct, is of value for the surgeon when planning the operation.
对3例胰岛素瘤患者进行了内镜逆行胰胆管造影（ERCP）。1例有大的恶性肿瘤，其余2例有小肿瘤。其中2例患者收集了胰液用于C肽测定。对另外7名受试者进行了胰管造影并获取了胰液，这7名受试者包括：5名对照受试者和2例因低血糖症状而怀疑患有胰岛素瘤的患者。除了1例患有大胰岛素瘤且发现主胰管梗阻的患者外，所有受试者的胰管造影均正常。发现胰岛素瘤患者胰液中的最大C肽浓度比对照受试者以及1例怀疑患有胰岛素瘤但未得到证实的患者高出几倍。另1例疑似胰岛素瘤患者的最大C肽浓度与确诊为胰岛素瘤的患者相当。因此，发现有无胰岛素瘤患者的最大C肽浓度存在显著差异。然而，这些发现的临床意义需要进一步评估。ERCP对疑似胰岛素瘤患者的价值可能有两方面：主胰管梗阻可能表明存在大的、难以切除的肿瘤；在胰管未受影响的患者中，血管造影显示的肿瘤与胰管之间的关系，对外科医生制定手术方案有一定价值。
