Defreyne L, König K, Lerch M M, Hesse U J, Rottiers R, Feifel G, de Hemptinne B, Kramann B, Kunnen M
Radiologie en Medische Beeldvorming, Vasculaire en Interventionele Radiologie, Universitair Ziekenhuis Gent, Belgium.
Abdom Imaging. 1998 May-Jun;23(3):322-31. doi: 10.1007/s002619900350.
To determine the accuracy and safety of a modified intra-arterial calcium stimulation with the venous sampling test (ASVS) for preoperative localization of insulinomas. Modification included stimulation with a fixed low dose of calcium gluconate, additional stimulation in the distal splenic artery, and no insulin sampling in the left hepatic vein.
In 10 patients showing biochemical evidence of organic hyperinsulinemia, 0.45 mmol of Ca2+ was injected into the gastroduodenal, superior mesenteric, proper hepatic, proximal, and distal splenic arteries during angiography. Insulin levels were measured in samples taken from the right hepatic vein before and 30, 60, 90, 120, 180, and 300 s after Ca2+ injection.
Insulin gradients with an increase of more than fourfold indicated direct tumor supply, two- to fourfold correlated with collateral supply, and less than twofold correlated with normal tissue vascularization. ASVS localized all the adenomas of the pancreatic head (n = 3) and body (n = 2) and two of four adenomas of the tail correctly, as confirmed by surgery. Two adenomas of the proximal pancreatic tail were erroneously localized to the body segment, but the fault was rectified by angiography. In one patient with a negative ASVS and without exploration, the diagnosis of an insulinoma was revised.
ASVS with a fixed low dose of calcium gluconate is a highly accurate and safe method for preoperative localization of insulinomas. Sampling in the left hepatic vein can be routinely omitted. Additional stimulation in the distal splenic artery seems helpful in surgical decision making, but additional experience is needed.
确定改良的动脉内钙刺激静脉采血试验（ASVS）用于胰岛素瘤术前定位的准确性和安全性。改良措施包括使用固定低剂量葡萄糖酸钙进行刺激、在脾动脉远端进行额外刺激以及不在左肝静脉采集胰岛素样本。
对10例有器质性高胰岛素血症生化证据的患者，在血管造影期间向胃十二指肠动脉、肠系膜上动脉、肝固有动脉、脾动脉近端和远端注入0.45 mmol的Ca2+。在注入Ca2+前以及注入后30、60、90、120、180和300秒从右肝静脉采集样本，测量胰岛素水平。
胰岛素梯度增加超过四倍表明肿瘤有直接供血，增加两到四倍与侧支供血相关，增加不到两倍与正常组织血管化相关。经手术证实，ASVS正确定位了所有胰头腺瘤（n = 3）、胰体腺瘤（n = 2）以及四个胰尾腺瘤中的两个。胰尾近端的两个腺瘤被错误定位到胰体段，但通过血管造影得以纠正。在一名ASVS结果为阴性且未进行探查的患者中，胰岛素瘤的诊断被修正。
使用固定低剂量葡萄糖酸钙的ASVS是一种用于胰岛素瘤术前定位的高度准确且安全的方法。可常规省略在左肝静脉的采血。在脾动脉远端进行额外刺激似乎有助于手术决策，但还需要更多经验。
