术中超声在胰岛素瘤手术中的应用价值

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、EUS、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。     

灰阶超声造影与增强CT、MRI在胰岛素瘤诊断中的对比研究

目的 探讨超声造影、增强CT和MRI对胰岛素瘤术前定位诊断的价值.方法 回顾性分析31例有明确术后病理诊断的胰岛素瘤患者的影像学资料.在术前31例患者均进行了超声造影检查,30例进行了增强CT检查,28例进行了MRI检查.结合手术病理结果,比较分析以上3种影像学方法对胰岛素瘤术前诊断的价值.结果 超声造影、增强CT及MRI对胰岛素的检出率分别为96.8%、63.3%、96.2%,超声造影高于增强CT(P=0.0018),与MRI结果一致(P=0.1828).结论 超声造影诊断胰岛素瘤的准确率较高,在胰岛素瘤的术前诊断中具有较大潜力.     

超声造影与DSA定位诊断胰岛素瘤

目的 比较超声造影(CEUS)和数字减影血管造影(DSA) 在胰岛素瘤定位诊断中的价值.方法 回顾性分析42例有明确术后病理诊断的胰岛素瘤患者的影像学资料,所有患者均行CEUS检查,29例行DSA检查,比较两种方法对胰岛素瘤的定位诊断准确率.结果 CEUS检查对胰岛素瘤检查准确率为90.48%,DSA检查的准确率为86.21%,两种检查方法对胰岛素瘤的定位诊断准确率差异无统计学意义.结论 CEUS可作为胰岛素瘤术前定位诊断的首选方法.     

术中超声在胰岛素瘤定位诊断及精准切除中的应用

目的探讨术中超声在胰岛素瘤定位诊断以及肿瘤精准切除中的应用价值。方法 18例胰岛素瘤患者均行术前经腹超声、增强CT扫描及术中超声检查,并对比分析结果。结果 18例患者共20个病灶,经腹部超声及螺旋薄层增强CT诊断准确率分别为75%、70%,而术中超声定位准确率100%;术中精准切除肿瘤14例。结论术中超声对胰岛素瘤定位准确,有助于肿瘤的尽可能精准切除,可减少手术创伤,保护胰腺外分泌功能,减少术后并发症,提高患者术后生活质量。     

术中超声在胰岛素瘤定位诊断及精准切除中的应用

目的探讨术中超声在胰岛素瘤定位诊断以及肿瘤精准切除中的应用价值。方法 18例胰岛素瘤患者均行术前经腹超声、增强CT扫描及术中超声检查,并对比分析结果。结果 18例患者共20个病灶,经腹部超声及螺旋薄层增强CT诊断准确率分别为75%、70%,而术中超声定位准确率100%;术中精准切除肿瘤14例。结论术中超声对胰岛素瘤定位准确,有助于肿瘤的尽可能精准切除,可减少手术创伤,保护胰腺外分泌功能,减少术后并发症,提高患者术后生活质量。     

术前经腹超声与术中超声诊断肝脏肿瘤的对比研究

目的 比较分析经腹超声(TAS)、术中超声(IOUS)两种诊断方法,探讨IOUS在肝脏肿瘤手术中的价值及优势.方法 对50 例肝脏肿瘤患者行术前经腹及术中超声检查,并与术中所见以及病理结果进行对比分析.结果 50例肝脏肿瘤共有肿瘤病灶79个,TAS、IOUS对肿瘤病灶诊断敏感度、特异度、准确性、阳性及阴性预测值分别为74.2%、83.3%、80.0%、74.2%、83.3%及 93.5%、95.8%、94.9%、93.5%、95.8%,IOUS高于术前TAS(P＜0.05).TAS、IOUS 对肿瘤定位准确率分别为70.0%及100%,IOUS高于TAS(P＜0.05),二者对肿瘤大小的检测差异无统计学意义.结论 IOUS相比于TAS检查具有更高的敏感性及特异性,并具有很高的定位准确性.     

超声造影与腹腔镜超声在胰岛素瘤定位诊断中的对比研究

目的 比较分析超声造影和腹腔镜超声对胰岛素瘤术前定位诊断的价值.方法 回顾性分析同期接受超声造影检查和术中腹腔镜超声检查的33例有明确术后病理诊断的胰岛素瘤患者的资料,比较两种影像学方法对胰岛素瘤定位诊断的准确性.结果 与手术病理结果比较,超声造影诊断胰岛素瘤的敏感性和准确率分别为92.3%(36/39)、90.0%(36/40);腹腔镜超声与病理结果完全一致;两种影像学技术对胰岛素瘤的定位诊断准确率差异无统计学意义(χ2=4.21,P=0.04).结论 超声造影有助于胰岛素瘤的术前定位诊断.对于进行腹腔镜下胰岛素瘤切除的患者,在肿瘤切除前推荐结合使用超声造影与腹腔镜超声进行定位检查.     

常规超声与超声造影在胰岛素瘤术前定位诊断中的对比研究

目的 比较分析常规超声与超声造影对胰岛素瘤术前定位诊断的价值.方法 回顾性分析经手术证实的47例胰岛素瘤患者的常规超声及超声造影图像,比较两种影像学方法对胰岛素瘤定位诊断的准确性.结果 与手术病理结果比较,常规超声诊断胰岛素瘤的敏感性和准确性均为27.7%;超声造影诊断胰岛素瘤的敏感性和准确性分别为91.5%、84.3%;两种影像学技术对胰岛素瘤的定位诊断准确率存在统计学差异(P<0.05,P＝0.0000).结论 在胰岛素瘤的术前定位诊断中,超声造影较常规超声定位更准确,在术前定位中具有重要的应用价值.     

探讨经腹超声造影与内镜超声联合应用对胰岛素瘤的术前定位的价值

目的 探讨经腹超声造影及超声内镜两种方法 联合对胰岛素瘤的术前定位的准确性.方法 44例明确诊断为胰岛素瘤的患者在我院进行胰岛素瘤术前定位,其中包括CT平扫加增强、超声造影、内镜超声,对比分析经腹超声造影及内镜超声联合应用与增强CT在胰岛素瘤定位诊断的准确性.结果 44例胰岛素瘤均经外科手术治疗;41例患者进行了术前CT平扫及增强CT检查,其中23例患者的肿瘤定位准确,准确率为56.1%,33例患者联合超声造影与内镜超声定位,30例患者定位准确(90.9%),联合超声造影与内镜超声的定位准确性与CT平扫加增强定位准确性存在统计学差异(P<0.05).结论 与CT平扫加增强比较,联合应用超声造影及内镜超声两种方法 可以显著提高胰岛细胞瘤定位诊断的准确性,值得在临床上进一步推广应用.     

CT、MRI和超声内镜对直肠癌诊断及临床分期有效性对比研究

目的:对比研究直肠癌诊断及临床分期中应用电子计算机断层扫描(CT)、磁共振成像(MRI)和超声内镜的有效性。方法:本次研究对象为本院2019年1月-2020年7月收治的46例直肠癌患者,术前分期检查分别采用CT、MRI和超声内镜,确诊依据为病理分析结果,分析在术前分期及直肠癌诊断中三种检查方式的临床意义。结果:超声内镜在T1、T2、T3期诊断准确率分别为87.50%、100.00%及77.78%,均高于CT诊断,差异明显(P0.05);CT、MRI和超声内镜在N0期、N1期、N2期诊断准确率比较,无明显差异(P0.05)。CT在M0和M1期诊断准确率均为100.00%,比较MRI,无明显差异(P0.05)。结论:在对直肠癌远处转移检测时,CT更有效,在T、N期MRI和超声内镜可起到更好的检出效果,CT、MRI和超声内镜联合使用,可对患者直肠癌进行更准确的诊断和术前分期。     

术中超声在胰岛素瘤定位诊断中的价值

目的 探讨术中超声在胰岛素瘤定位诊断中的价值。方法 对２８例胰岛素瘤患者的术前Ｂ超,ＣＴ,ＭＲＩ和选择性动脉造影检查的定位资料进行分析,统计了术中超声与术中门诊,术中脾门静脉穿刺置管分段取血快速胰岛素测定（ＰＶＳ）３种方法对胰岛素瘤的定位准确率,并进行了比较研究。     

Section 6. Digestive organs: Minimally invasive endocrine surgery: laparoscopic resection of insulinomas

Pancreatic insulinomas are mostly benign and solitary tumors. Successful management of patients with insulinoma relies on accurate localization of the tumors and the use of appropriate surgical techniques. However, preoperative radiological imaging studies often fail to localize the insulinomas because of the small tumor sizes. Conventional intraoperative ultrasonography combined with palpation has been widely used as the best localization tool. Since contact ultrasonography, a new technique for localizing pancreatic lesions, became available as a laparoscopic study, several surgeons have utilized laparoscopy for not only localization but also resection of insulinomas. Previous reports of laparoscopic ultrasonography for intraoperative identification of insulinomas showed a 100% success rate in cases with insulinoma localized by preoperative imaging studies, but a less satisfactory rate in cases with occult insulinoma. Laparoscopic resection of insulinomas located in the head of the pancreas is often difficult because of its anatomical relationship with important adjacent structures such as pancreatic duct and mesenteric vessels. In contrast, insulinomas located in the body or tail of the pancreas are laparoscopically resectable even when they are in close proximity to the major pancreatic duct. Laparoscopic procedure is a feasible technique with low morbidity for surgical management of insulinomas. Accurate preoperative localization is essential for safe performance of this minimally invasive procedure.     

术前及术中超声、CT及术中触诊诊断肝肿瘤的一致性评价

目的 评价术前超声、CT及术中超声、术中触诊诊断肝肿瘤良恶性的一致性.方法 分析70例肝肿瘤患者的术前超声、术前CT检查、术中超声以及术中触诊结果,对四种检查结果与病理及随访结果诊断肝肿瘤良恶性的一致性进行评价.结果 术前超声与病理及随访结果诊断肝肿瘤良恶性的一致性为中等(Kappa值0.63),术中触诊与病理及随访结果的诊断一致性较低(Kappa值0.38),CT以及术中超声检查与病理及随访结果诊断一致性较高(Kappa值分别为0.71及0.89),而术中超声与CT检查之间诊断一致性也较高(Kappa值为0.53).而术前超声与术中超声以及术前超声与术中触诊之间诊断一致性均较低(Kappa值均为0.23).结论 在肝肿瘤诊断评价中,CT与术中超声具有较高的诊断一致性,虽然术前超声与术中触诊诊断结果一致性较低,但在临床工作中依然不可或缺,而若能将四者结合应用,将有助于肝肿瘤的诊断与治疗.     

术中超声在胰腺外科中的应用

目的：探讨术中超声在胰腺外科手术中的应用,评价术中超声的临床价值。方法：回顾性分析2007年2月—2010年1月间我院胰腺外科应用CT、经腹超声及术中超声检查结果,并与手术病理对照。应用指征主要是术前诊断不清晰、定位不明确、解剖关系复杂或术中触诊与影像资料相矛盾的病例。结果：14例患者中胰岛素瘤4例,实性假乳头状瘤4例,3例为胰腺炎,1例为腺癌,1例囊肿术后取石,1例经术中穿刺证实未见明显占位而放弃手术。CT病变检出率92.3%（12/13）,诊断正确率为71.4%（10/14）;经腹超声检出率为83.3%（10/12）,正确率为53.8%（7/13）;所有病变均经术中超声检出,术中超声检出率及诊断正确率与CT相比有所提高,与术前经腹超声比较有明显统计学差异。腹腔镜手术中超声发现2例病变侵犯血管而转为开腹手术。结论：术中超声不仅能提高病变的显示率及诊断率,同时对指导术式选择也具有重要意义。     

胰岛素瘤的诊治分析(附13例报告)

目的总结胰岛素瘤的外科诊治经验。方法对13例胰岛素瘤患者的临床资料进行回顾性分析。结果本组患者均有典型的Whipple三联症表现,5例患者曾被误诊;术前B超、CT、选择性腹腔动脉造影、磁共振成像（MRI）的定位率分别为44％、50％、71％和33％;术中13例患者经触诊定位11例,2例经术中B超均获定位;术后12例治愈,1例死于复发。结论胰岛素瘤误诊率较高,必要的辅助检查有助于肿瘤的定位,手术方式的选择应根据肿瘤的部位、大小、数量而定,手术治疗效果良好。     

Intraoperative liver ultrasound: the Chinese experience

This article introduces the experience in intraoperative liver ultrasound in China. Intraoperative liver ultrasound was mainly used in patients treated for hepatocellular carcinoma (HCC) and hepatolithiasis, with purposes for further diagnosis and decision making and guidance of surgical procedures. With respect to detection of liver tumors, intraoperative ultrasound (IOUS) was significantly more sensitive, especially in small foci, as compared with preoperative ultrasound and computed tomography scanning, as well as intraoperative inspection and palpation. It was also more precise in localizing lesions than preoperative imaging investigations. Intraoperative echoangiography via hepatic arterial injection of carbon dioxide was shown not only to help assess position of catheter and vascularity of tumors but also to improve sensitivity in detecting small tumor foci in patients undergoing hepatic arterial chemoembolization. Intraoperative ultrasound was also used to guide hepatectomies. It ensured to obtain curative resection of the tumors and maximum preservation of functioning hepatic parenchyma simultaneously. For hepatolithiasis, IOUS offered accurate localization of stones, lithotomy (with its guidance), reduction of the rate of residual stones, and follow-up of the outcome of lithotomy.     

术中B超在肝癌切除术中的应用

目的：评价术中B超在原发性肝癌手术切除中的应用价值；比较术中B超引导下的肝癌切除术、术中B超引导下肝段门静脉阻断灌注化疗并肝段染色后肝癌切除术与常规肝癌切除术的临床疗效。方法：56倒肝癌病人在术中B超引导下进行肝癌切除术；41例肝癌病人应用术中B超引导肝段门静脉阻断灌注化疗并肝段染色后行肝癌切除术；35例行常规肝癌切除术。术后定期复查肝功能、AFP，CT及MRI，并随访。结果：术中B超对直径〈3cm小肿瘤检出阳性率为93．1％，直径〉3cm为100％；应用术中B超使19．6％（19／97）的病人改变了原手术方案；术中B超引导下的肝癌切除组和B超引导下肝段门静脉阻断灌注化疗并肝段染色后肝癌切除组较常规肝癌切除组术中出血少，对肝功能影响小，其术后5年生存率分别为31．9％、37．8％和24．3％；局部复发率分别为33．9％、31．7％和57.1％。结论：术中B超对肝癌定位准确，能够提高手术安全性、彻底性和合理性；B超引导下肝段门静脉阻断灌注化疗并肝段染色后肝癌切除组的临床疗效优于术中B超引导下的肝癌切除组，且它们明显优于常规肝癌切除组。     

成人肾上腺术中超声表现

目的 观察成人肾上腺术中超声（IOUS）表现。方法 收集71例因肝脏、胆道或胰腺病变而接受外科手术治疗患者,观察肾上腺IOUS表现,并与CT/MRI双侧肾上腺显示率和厚度测值进行比较。结果 成人肾上腺IOUS表现为边界清晰、形态不规则的双侧弱回声结构。CT/MRI肾上腺显示率为97.18%（138/142）。IOUS肾上腺显示率为95.07%（135/142）,右侧92.96%（66/71）、左侧97.18%（69/71）,且可见4侧CT/MRI未能显示的肾上腺;IOUS所测肾上腺厚度均大于CT/MRI（P均<0.05）。结论 IOUS中,成人肾上腺表现为边界清晰、形态不规则的双侧弱回声,左侧显示率高于右侧。     

Value of diagnostic localization of insulinoma

The value of diagnostic localization of insulinoma The value of diagnostic localization statements are contradictory. Basing on our own patient material (n = 41) the preoperative localization of an insulinoma was correct with sonography in 57.7%, with computed tomography in 21.4%, with computed tomography with bolus injection of contrast medium in 73.3%, with angiography 63.9% and with percutaneous transhepatic portal vein catheterisation with selective test of hormones (PTP) in 76.9%. Intraoperative 38 of 41 insulinomas were palpable and twelve of 16 insulinomas were seen during intraoperative sonography. Although we palpate more than 90% of all insulinomas we support a preoperative diagnostic localization for easier intraoperative palpation.     

The value of intraoperative ultrasound during hepatic resection compared with improved preoperative magnetic resonance imaging

BACKGROUND: Patients with colorectal metastases confined to the liver may be cured by resection. Combined bimanual palpation and intraoperative ultrasound (IOUS) augment the detection of colorectal hepatic metastases. The importance of IOUS in the surgical management of hepatic tumors has been demonstrated and should arguably be considered the final diagnostic procedure. OBJECTIVE: To determine the relevance of routine IOUS prior to hepatic resection compared with improved preoperative Magnetic resonance imaging (MRI). PATIENTS AND METHODS: Eighty patients with metastatic colorectal adenocarcinoma underwent hepatic resection between 1998 and 2001. The IOUS results were compared with preoperative MRI, bimanual palpation, and resection histopathology. The preoperative surgical plan was compared with the surgical procedure performed. Data were retrospectively analyzed. RESULTS: IOUS provided additional useful information not available preoperatively for 37 (47%) patients, including the identification of subcentimetre metastatic lesions, characterization of the lesion, and the anatomy of the hepatic vasculature. The preoperative surgical plan was changed secondary to the IOUS findings alone in 14/80 (18%) patients. IOUS did not provide any additional useful information for 43 (53%) patients. A correlation was demonstrated between the preoperative diagnosis, intraoperative findings, and resection histopathology. CONCLUSION: Accurate diagnostic studies facilitate critically decisive actions during planned hepatic resection(s). The current findings suggest that IOUS provide the most useful additional information for hepatic lesions, despite recent improvements in preoperative MRI scanning. Furthermore, routine IOUS should be employed during hepatic resection for colorectal metastases.