【摘要】 目的:评价动脉内钙剂刺激试验在功能性胰岛素瘤术前定位诊断中的作用。方法:对10例胰岛素瘤患者行动脉内钙剂刺激肝静脉采血试验(ASVS)测定胰岛素的研究,ASVS前均行超声、CT、MRI及内镜超声检查。10例功能性胰岛素瘤均得到手术病理证实,病灶大小为0．8-2．0 cm。分别行胃十二指肠动脉(GDA)、肠系膜上动脉(SMA)、脾动脉近端(sAP)和脾动脉远端(SAD)造影,并通过导管注射钙剂5 m1(含Ca2+约27 mg),于每次动脉刺激后30、60、90、120、 150和180 s行右肝静脉取血测定胰岛素:不同动脉激发试验的间隔时间为15 min。阳性判断标准:若胰岛素峰值达到或超过基础值的4倍以上,即提示该动脉为肿瘤的供血动脉,肿瘤即被定位于相对应的胰腺区域。结果:10例中9例ASVS 结果与最终诊断完全一致,1例肿瘤位于胰尾,因未行SAD激发而漏诊。结论:ASVS是功能性胰岛素瘤安全、准确的术前定位方法,尤其适用于病灶较小、其他影像学检查结果为阴性的病例。更多还原

【Abstract】 Objective:To evaluate the role of intra-arterial calcium stimulation with venous sampling (ASVS) in the localization of the hyperfunctioning insulinornas in pancreas before surgery. Methods: Ten consecutively admitted patients with clinically proved pancreatic insulinornas were studied with ASVS for measuring the insulin level and localizing the site of the tumor. All of the patients had ultrasonography,CT,MRI and endoscopic ultrasonography prior to ASVS test. During the interventional procedure, angiography for demonstrating the feeding arteries including gastroduodenal artery (GDA) , superior mesenteric artery (SMA),proximal and distal splenic artery (SAP and SAD) were performed before the patient underwent ASVS test. And all of these arteries were selectivly catheterized for rapid infusion of 5ml calcium gluconate and the blood was sampled through the right hepatic vein prior to and 30,60,90,120,150 and 180 s after stimulation for defining the insulin level. A gap of 15 min between every two stimulations was preserved. The tumor would be regionalized in the corresponding area if the peak value of insulin after stimulation in certain artery reached or higher than 4 times of the baseline level. Results:Ten cases with insulinoma with the size as 0. 8-2. 0 cm were proved by surgery and pathology. The results of ASVS were identical to the final diagnosis in 9 cases. In 1 case,peak value couldn’t be obtained due to the location of tumor at the tail of pancreas, and complete ASVS examination could not be done without stimulating the SAD. Conclusion: The ASVS test is a safe and accurate technique in the localization of the hyperfunctioning insulinornas in pancreas before surgery,especially for the small lesion which can not be detected by other imaging modalities.更多还原