Thompson N W, Czako P F, Fritts L L, Bude R, Bansal R, Nostrant T T, Scheiman J M
Department of Surgery, University of Michigan Medical Center, Ann Arbor.
Surgery. 1994 Dec;116(6):1131-8.
We have previously found selective venous sampling to be the most sensitive method to localize otherwise occult functioning endocrine tumors. However, recently we have used endoscopic ultrasonography (EUS) as the initial and in some cases the only localization study in the preoperative evaluation of proven insulinomas and of selected cases of gastrinoma.
All patients referred between April 1993 and April 1994 with a subsequently confirmed diagnosis of organic hyperinsulinism or Zollinger-Ellison syndrome (ZES) underwent EUS. Ten patients with insulinomas and six with gastrinomas were studied. Only one patient with ZES had multiple endocrine neoplasia type I. Patients with negative EUS findings had additional localization procedures including angiography and arterial stimulation tests. All but one patient underwent surgical exploration.
Solitary insulinomas were found in all 10 patients. EUS correctly identified and localized the insulinoma in seven (70%) of 10 patients but failed to identify two pedunculated insulinomas that were easily found at exploration. Because of an incomplete examination, a single insulinoma was not detected within the parenchyma. The EUS examination correctly excluded the pancreatic gastrinomas in five patients. The sixth patient, who had multiple endocrine neoplasia type I, had two 0.5 cm tumors in the head.
EUS is a sensitive and cost-effective technique for localization of insulinomas and may be the only study needed. In patients with ZES a negative pancreatic result suggests the likelihood of a duodenal or other extrapancreatic tumor.
我们之前发现选择性静脉采血是定位隐匿性功能性内分泌肿瘤最敏感的方法。然而，最近我们已将内镜超声检查（EUS）作为确诊胰岛素瘤和部分胃泌素瘤术前评估的初始及某些情况下唯一的定位检查。
1993年4月至1994年4月间所有转诊且随后确诊为器质性高胰岛素血症或卓-艾综合征（ZES）的患者均接受了EUS检查。研究了10例胰岛素瘤患者和6例胃泌素瘤患者。仅1例ZES患者患有I型多发性内分泌腺瘤病。EUS检查结果阴性的患者接受了包括血管造影和动脉刺激试验在内的其他定位检查。除1例患者外，所有患者均接受了手术探查。
10例患者均发现了孤立性胰岛素瘤。EUS在10例患者中的7例（70%）中正确识别并定位了胰岛素瘤，但未能识别出在探查时容易发现的2例带蒂胰岛素瘤。由于检查不完整，1例实质内的胰岛素瘤未被检测到。EUS检查正确排除了5例患者胰腺胃泌素瘤。第6例患有I型多发性内分泌腺瘤病的患者在胰头有2个0.5 cm的肿瘤。
EUS是一种用于胰岛素瘤定位的敏感且经济有效的技术，可能是唯一需要的检查。在ZES患者中，胰腺检查结果为阴性提示十二指肠或其他胰腺外肿瘤的可能性。
