动脉钙剂激发肝静脉采血测定胰岛素在胰岛素瘤术前定位中的应用  

Application of arterial calcium stimulation and venous sampling in the preoperative localization of insulinoma

作　　者：王晨 柴伟栋[2] 王杰[2] 陈家伟[3] WANG Chen;CHAI Weidong;WANG Jie(Department of Digestive Endoscopy, First Affiliated Hospital , Nanjing Medical University, Nanjing 210029, CHINA)

机构地区：[1]南京医科大学第一附属医院消化内镜科,江苏210029 [2]南京医科大学第一附属医院介入放射科,江苏210029 [3]南京医科大学第一附属医院内分泌科,江苏210029

出　　处：《江苏医药》2019年第8期790-793,共4页Jiangsu Medical Journal

摘　　要：目的探讨术前应用经动脉钙剂激发肝静脉采血(ASVS)测定胰岛素定位胰岛素瘤的临床意义。方法对7例临床诊断为胰岛素瘤的患者行术前ASVS检查,分别经肠系膜上动脉、胃十二指肠动脉、脾动脉近段和脾动脉远段快速注入钙剂激发,在激发后0、30、60、90、120、180 s经肝静脉采血测定胰岛素水平。计算各动脉激发值与基础值之比,将比值最高的动脉所供应的胰腺区域拟为肿瘤所处的区域。结果 7例患者均为单发胰岛素瘤;其中,6例ASVS定位结果与手术病理结果相一致。术前采用ASVS、腹部B超、CT和MRI检查定位胰岛素瘤的灵敏度分别为100%、50.0%、75.0%和100%,准确度分别为85.7%、28.6%、42.9%和50.0%。结论 ASVS对胰岛素瘤的术前定位诊断准确度高,适用于常规影像学检查阴性或结果不相一致的隐匿型胰岛素瘤。Objective To evaluate the clinical significance of arterial calcium stimulation and venous sampling(ASVS) in the preoperative localization of insulinoma.Methods Seven patients with clinically diagnosed insulinomas underwent ASVS examination before operation,which was performed by quickly injecting calcium gluconate via gastroduodenal artery,superior mensenteric artery,proximal and distal splenic arteries.Serum insulin level of hepatic vein blood was detected at 0,30,60,90,120 and 180 seconds after arterial calcium stimulation.The ratio of insulin value after calcium stimulation to its basic value was calculated.The artery with the highest ratio was considered to be the feeding artery of insulinoma.Results The single insulinoma was postoperatively confirmed in 7 patients.The localization result of ASVS in 6 cases was consistent with the final diagnosis.For preoperatively localizing the insulinoma,the sensitivity of ASVS,abdominal ultrasound,CT and MRI was 100%,50.0%,75.0% and 100% and the accuracy of which was 85.7%,28.6%,42.9% and 50.0%,respectively.Conclusion The accuracy of ASVS in the preoperative localization of insulinoma is high,which is especially suitable for localizing the occult insulinomas with negative or contradictory findings by the conventional imaging examinations.

关 键 词：胰岛素瘤 动脉钙剂激发肝静脉采血 定位诊断 

分 类 号：R445[医药卫生—影像医学与核医学]