Brown C K, Bartlett D L, Doppman J L, Gorden P, Libutti S K, Fraker D L, Shawker T H, Skarulis M C, Alexander H R
Surgical Metabolism Section, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
Surgery. 1997 Dec;122(6):1189-93; discussion 1193-4. doi: 10.1016/s0039-6060(97)90226-9.
Standard imaging studies (computed tomography, magnetic resonance imaging, somatostatin receptor scintigraphy, ultrasonography, and angiography) correctly localize insulinomas in less than 50% of patients and provide no information about the feasibility of enucleation based on proximity of tumor to pancreatic duct. We reviewed our experience with intraarterial calcium stimulation (Ca-Stim) and intraoperative ultrasonography (IOUS) to localize and guide management of insulinomas.
Thirty-six patients (14 men, 22 women, median age 44 years) with insulinomas were treated between August 1989 and June 1996. Preoperative imaging studies were obtained. Patients underwent abdominal exploration with IOUS. Fourteen were evaluated by a surgeon blinded to preoperative imaging results.
Tumors (4 to 50 mm) were resected by enucleation (67%) or partial pancreatectomy (33%); all were cured. Sensitivities of computed tomography, magnetic resonance imaging, somatostatin receptor scintigraphy, ultrasonography, angiography, and Ca-Stim in localizing insulinomas were 24%, 45%, 17%, 13%, 43%, and 94%, respectively. Tumors were identified by blinded surgical exploration with IOUS in 12 of 14 patients (86%).
All insulinomas were identified before operation; however sensitivity of individual noninvasive tests was low (less than 50%). In contrast, Ca-Stim was correct in 94% of cases, thus allowing a focused pancreatic exploration and obviating use of blind distal pancreatectomy. IOUS can then be used to guide safe enucleation.
标准影像学检查（计算机断层扫描、磁共振成像、生长抑素受体闪烁显像、超声检查和血管造影）在不到50%的患者中能正确定位胰岛素瘤，且无法提供基于肿瘤与胰管距离的剜除可行性信息。我们回顾了我们在动脉内钙刺激（Ca-Stim）和术中超声检查（IOUS）用于胰岛素瘤定位及指导治疗方面的经验。
1989年8月至1996年6月期间，对36例胰岛素瘤患者（14例男性，22例女性，中位年龄44岁）进行了治疗。术前行影像学检查。患者接受了IOUS腹部探查。14例患者由对术前影像学结果不知情的外科医生进行评估。
肿瘤（4至50毫米）通过剜除术（67%）或部分胰腺切除术（33%）切除；所有患者均治愈。计算机断层扫描、磁共振成像、生长抑素受体闪烁显像、超声检查、血管造影和Ca-Stim在定位胰岛素瘤方面的敏感性分别为24%、45%、17%、13%、43%和94%。在14例患者中的12例（86%）通过不知情的外科手术探查及IOUS发现了肿瘤。
所有胰岛素瘤在手术前均被发现；然而，单个非侵入性检查的敏感性较低（低于50%）。相比之下，Ca-Stim在94%的病例中是正确的，从而能够进行有针对性的胰腺探查并避免使用盲目远端胰腺切除术。然后可以使用IOUS来指导安全的剜除术。
