经动脉钙剂刺激试验术前定位诊断胰岛素瘤的价值

Value of the calcium intraarterial stimulation test in preoperative localization of insulinoma

目的 评价经动脉钙剂刺激试验对胰岛素瘤术前定位的诊断作用。方法 对 16例临床疑为胰岛素瘤而胰腺B超和CT检查均阴性的患者 ,术前应用经动脉钙剂刺激肝静脉取血测定胰岛素 (ASVS)的方法进行肿瘤定位。经各供胰动脉分别注射葡萄糖酸钙 ,在注射前及注射后 30、6 0、90、12 0、15 0s分别取 2ml肝静脉血测定胰岛素。动脉刺激后血胰岛素水平的峰值超过基础值 2倍以上 ,则确定肿瘤位于该动脉供应的胰腺区域。结果 16例患者 ,手术和病理证实孤立性胰岛素瘤12例和胰岛细胞增生 1例 ,除 1例胰岛素瘤外 ,ASVS对肿瘤均做出了准确定位 ;另 3例经手术探查或随访排除胰岛素瘤 ,ASVS结果亦为阴性。因此ASVS术前定位胰岛素瘤或胰岛细胞增生的敏感性为92 3%(12 / 13) ,特异性为 10 0 %(3/ 3) ,准确性为 93 7%(15 / 16 )。结论 经动脉钙剂刺激肝静脉取血测定胰岛素的方法安全准确 ,适用于其他影像学检查阴性的胰岛素瘤的术前定位。

Objective To evaluate the efficacy of the intraarterial calcium test in preoperative localization of insulinomas. Methods Sixteen patients with suspected insulinoma underwent ASVS method, which meant injecting calcium stimulant into pancreatic arteries and then taking blood specimens from hepatic vein to gauge the insulin levels. Six samples, each 2 ml, were taken before and 30, 60, 90, 120, 150 seconds after the injection. Results Twelve solitary insulinomas and one hyperplasia were diagnosed after surgery. Except one insulinoma, ASVS allowed accurate localization of the tumor. For the other three cases, which were excluded the diagnosis of insulinoma by surgical exploration or follow-up, ASVS were negative. Thus the sensitivity, specificity, and overall accuracy of ASVS were 92.3%(12/13), 100%(3/3), and 93.7%(15/16), respectively. Conclusion ASVS is an accurate and safe technique to localize insulinomas, especially for those undetectable at preoperative morphologic studies.