术中超声在胰岛素瘤手术中的应用价值

Value of intraoperative ultrasonogaphy in operation for insulinoma

目的:比较分析胰岛素瘤术前、术中的各类定位检查方法,探讨术中超声(IOUS)在其手术中的应用价值。方法:对44例(45处病灶)胰岛素瘤患者术前及术中检查方法的灵敏度进行回顾性统计,并以病理结果为对照。总结IOUS观察病灶的二维灰阶声像图特征、血流状况及其与邻近重要解剖结构的关系。结果:经腹超声(TAUS)、内镜超声(EUS)、CT、MRI、CTA及选择性动脉钙刺激肝静脉采血测胰岛素(ASVS)检测的病灶定位灵敏度分别为35.6% (16/45)、66.7%(6/9)、69.0%(29/42)、63.6%(14/22)、75.0%(3/4)和81.8%(9/11)。术中触诊和IOUS术中定位的灵敏度分别为75.6%(34/45)和100%(19/19)。IOUS与TAUS、EIAS、CT、MRI、术中触诊的定位灵敏度差异有统计学意义(P<0.05)。有5例IOUS提示病灶与主胰管或血管关系密切,故在手术中采取了相应的保护措施。结论:在胰岛素瘤手术中,IOUS定位准确率高,且可同时观察肿瘤的毗邻结构,对选择合适的手术方式、提高手术切除率、减少术后并发症有重要意义。

Objective To compare various pre- and intra-operative localization methods for insulinoma and to evaluate the use of intraoperative ultrasonography （IOUS）in the operation for insulinoma. Methods The sensitivity of various pre- and intra-operative localization methods were analyzed retrospectively in 44 patients with 45 insulinomas confirmed pathologically. IOUS was used for observing the ultrasonographic characteristics and blood flow status of insulinomas as well as their anatomical relation with adjacent vital structures. Results The sensitivites of pre-operative localization by trans-abdominal ultrasonography （TAUS）, endoscopic ultrasonography （EUS）, computed tomography （CT）, magnetic resonance imaging （MRI）, CT angiography （CTA） and intra-arterial calcium stimulated venous sampling （ASVS） were 35.6% （16/45）, 66.7% （6/9）, 69.0% （29/42）, 63.6% （14/22）, 75.0% （3/4） and 81.8% （9/11）, respectively. The sensitivity of localization by intraoperative palpation was 75.6%（34/45） and that of IOUS was 100%（19/19）. The sensitivity of IOUS for localization of insulinoma was significantly higher than that of TAUS, CT, MRI, CTA, ASVS and intra-operative palpation. In 5 insulinomas, IOUS revealed their close anatomical relation with main pancreatic duct and critical blood vessels, which were protected by surgeons in the successive operation. Conclusions IOUS has a high accurate rate in localizing insulinoma and could provide a clear view of the relation between tumor and adjacent structures so that the surgeon could select appropriate surgical procedure to increase the operative resection rate and reduce the incidence of postoperative complication.