动脉钙刺激静脉采血检查术前定位胰岛素瘤的临床价值

Clinical value of intraarterial calcium stimulation and venous sampling in preoperative localization of insulinoma

目的评价动脉钙刺激静脉采血(ASVS)检查术前定位胰岛素瘤的临床价值。方法对12例临床定性诊断为胰岛素瘤患者术前行ASVS检查,选择性插管至胃十二指肠动脉、肠系膜上动脉、脾动脉近段和远段,分别快速注入葡萄糖酸钙激发,于激发前和激发后30、60、90、120、150和180 s经肝静脉采血测胰岛素值,计算不同激发值与基础值之比值,将比值最高者的动脉所供应的胰腺区域认定为肿瘤所在区域。结果ASVS定位准确性为83.3%,优于经腹超声(33.3%)、内镜超声(42.9%)、CT(75%)、MR(80%)和选择性血管造影(16.7%)。结论ASVS在胰岛素瘤术前定位中准确率高而且安全,尤其适合于其他形态学检查阴性的隐匿型胰岛素瘤。

Objective To evaluate the clinical value of intraarterial calcium stimulation and venous sampling （ASVS） for localization of insulinoma preoperatively. Methods Twelve patients with clinically proved insulinoma underwent ASVS test. Gastroduodenal artery, superior mensenteric artery, proximal and distal splenic arteries were selectively catheterized for stimulation by rapid injection of calcium gluconate. Blood was sampled through hepatic vein before and 30, 60, 90, 120, 150, 180 s after stimulation for gauging the insulin levels. The tumor site was considered to be at the corresponding area supplied with certain artery stimulated showing the peak ratio of insulin to the baseline. Results Accuracy of ASVS was 83.3%, demonstrating the superiority over TAUS （33.3%）, EUS （42.9%）, CT （75%）, MR （80%）, and SAG （ 16.7% ）. Conclusion ASVS is an accurate and safe technique to localize insulinomas preoperatively, especially for occult insulinomas with negative findings in morphologic studies.