不同影像学检查方法对胰岛素瘤术前定位诊断价值的探讨  

Different imaging techniques in localization and diagnosis of insulinoma

作　　者：谷秀莲[1] 窦京涛[1] 谷伟军[1] 杨国庆[1] 杜锦[1] 陈康[1] 杨丽娟[1] 臧丽[1] 王先令[1] 金楠[1] 吕朝晖[1] 巴建明[1] 母义明[1] 陆菊明[1] 李江源[1] 潘长玉[1] 

机构地区：[1]解放军总医院内分泌科全军内分泌代谢重点实验室,北京100853

出　　处：《中华全科医师杂志》2015年第4期274-277,共4页Chinese Journal of General Practitioners

摘　　要：目的 分析不同影像学检查方法对胰岛素瘤术前定位的诊断价值.方法 回顾性分析1985年1月到2014年5月于解放军总医院就诊并经手术病理证实的210例胰岛素瘤患者的临床资料.结果 92.4％ （194/210）的患者有典型的Wipple三联征,病程中监测低血糖发作时的血糖＜2.8 mmol/L,90.6％（163/180）的患者血胰岛素与血糖比值（INS/BG） ＞0.3.不同影像学检查方法的阳性率分别为：超声检查33.5％（62/185）、CT检查66.0％（128/194）、MRI检查72.5％（58/80）、超声内镜94.5％ （104/110）、数字减影血管造影（DSA） 83.2％（109/131）、超声造影96.8％ （92/95）.不同诊断方法阳性率比较,超声造影与超声内镜检查差异无统计学意义（χ^2=0.64,P=0.42）,均明显优于DSA、MRI、CT和超声（χ^2=7.48,P=0.00）.结论 胰岛素瘤的术前定位诊断方法有多种,超声造影阳性率最高,且相对廉价、简便易行,明显优于其他影像学检查,可作为术前定位诊断的首选.Objective To evaluate the application of different imaging techniques in diagnosis and localization of insulinoma.Methods The clinical data of 210 patients with insulinoma who underwent surgical treatment in Chinese PLA General Hospital from January 1985 to May 2014 were retrospectively reviewed.Results The typical ＆quot;Whipple Triad＆quot; was presented in 92.4% （194/210） patients,and their venous blood glucose levels were lower than 2.8 mmol/L The ratio of insulin to blood glucose was over 0.3 in 90.6% （163/180） patients.The positive rate of insulinoma localization by ultrasonography,CT,MRI,digital subtraction angiography （DSA）,endoscopic ultrasonography （EUS） and contrast-enhanced ultrasonography （CEUS） were 33.5% （62/185）,66.0% （128/194）,72.5% （58/80）,94.5% （104/ 110）,83.2% （109/131）and 96.8% （92/95）respectively.EUS and CEUS had significantly higher positive rate in localizing insulinoma compared to other imaging techniques （χ^2 =7.48,P =0.00） ; there was no significant difference between EUS and CEUS （χ^2 =0.64,P =0.42）.Conclusion Compared to other imaging techniques EUS and CEUS are more sensitive in diagnosis and localization of insulinoma; particularly,CEUS as a low-cost and simple method,should be used for preoperative diagnosis of insulinoma.

关 键 词：胰岛素瘤 定位诊断 超声造影 

分 类 号：R736.7[医药卫生—肿瘤]