术中超声检查在胰岛素瘤定位诊断中的应用

目的探讨术中超声（IOUS）检查在胰岛素瘤定位诊断中的的应用价值。方法对15例已经作出定性诊断的胰岛素瘤患者进行IOUS检查。结果 15例胰岛素瘤患者IOUS检查均作出定位诊断。结论 IOUS检查可对胰岛素瘤作出准确的定位诊断,同时显示肿瘤和周围器官的关系,有助于手术方式的选择,并可指导准确切除肿瘤,减少并发症。     

胰岛素瘤的术前定性及定位诊断99例分析

目的 分析不同的激素检查和影像学检查方法对胰岛素瘤术前诊断的价值。方法 回顾性总结分析北京协和医院1989年12月至2005年8月入院的有明确术后病理诊断的胰岛素瘤患者的临床资料。结果 本组患者的临床表现以昏迷、体重增加、大汗、定向力障碍、记忆力减退、头晕头痛为主。空腹血糖低于2．78mmol／L对于诊断胰岛素瘤的敏感性为66．6％；发作时的血清胰岛素血糖比值大于0．3的敏感性为89．7％；常用的影像学检查中胰腺灌注CT的敏感性最高，可达100.0％。结论 典型的Whipple三联症和低血糖时的血清胰岛素血糖比值大于0．3是胰岛素瘤定性诊断的重要依据。目前常用的影像学检查手段中，胰腺灌注CT对于胰岛素瘤诊断的敏感性和特异性最高。     

胰岛素瘤的术前及术中定位诊断方法的探讨

目的 探讨胰岛素瘤术前、术中定位方法的诊断价值,以提高胰岛素瘤定位的准确性.方法 对75例经手术病理证实的胰岛素瘤患者术前B超、CT、MRI的定位资料进行分析,统计术中触诊、术中超声(IOUS)等方法对胰岛素瘤的定位诊断准确率,并进行总结分析.结果 术前B超检查75例,23例发现肿瘤,诊断正确率30.7%;CT检查60例,24例发现肿瘤,诊断正确率40.0%;行MRI 48例,22例发现肿瘤,诊断正确率为45.8%.而术中扪诊、IOUS定位准确率分别为80.4%和96.4%术中定位率比术前明显提高.结论 胰岛索瘤的术前定位诊断比较困难,术中探查和术中B超检查的准确性很高,可不必强调术前准确定位和多种影像学重复检查.     

胰岛素瘤的术前定性及定位诊断99例分析

目的分析不同的激素检查和影像学检查方法对胰岛素瘤术前诊断的价值。方法回顾性总结分析北京协和医院1989年12月至2005年8月入院的有明确术后病理诊断的胰岛素瘤患者的临床资料。结果本组患者的临床表现以昏迷、体重增加、大汗、定向力障碍、记忆力减退、头晕头痛为主。空腹血糖低于2.78mmol/L对于诊断胰岛素瘤的敏感性为66.6%;发作时的血清胰岛素血糖比值大于0.3的敏感性为89.7%;常用的影像学检查中胰腺灌注CT的敏感性最高,可达100.0%。结论典型的Whipple三联症和低血糖时的血清胰岛素血糖比值大于0.3是胰岛素瘤定性诊断的重要依据。目前常用的影像学检查手段中,胰腺灌注CT对于胰岛素瘤诊断的敏感性和特异性最高。     

胰岛素瘤术前影像学定位诊断价值的探讨

目的 分析1985年以来不同阶段各项影像学方法对胰岛素瘤术前定位诊断的价值.方法 回顾性分析1985年1月到2008年4月就诊于解放军总医院内分泌科并行手术病理确诊的100例胰岛素瘤患者的临床资料,时间划分以引入新的影像学方法为准.结果 所有患者均有典型的Whipple三联征表现,病程3周至25年.95例患者住院期间监测到的最低血糖波动在0.3～2.5 mmol/L之间.其中91例血浆胰岛素/血糖(INS/G)>0.3.各项术前定位影像方法的阳性率如下:1985-1999年,B超5.3%(1/19),胰腺CT 31.6%(6/19),胰腺MRI 0(0/2),胰腺血管造影DSA 50.0%(5/10).2000-2006年,B超24.1%(7/29),胰腺CT 52.6%(20/38),胰腺MRI 40.0%(2/5),胰腺血管造影DSA 84.6%(22/26),内镜下超声EUS 100.0%(24/24).2007年至2008年4月,B超32.0%(8/25),胰腺CT 61.5%(16/26),胰腺MRI 87.5%(7/8),胰腺血管造影DSA 76.9%(20/26),内镜下超声EUS 94.7%(18/19),超声造影UC 94.4%(17/18).结论 各项影像定位检查价值差异很大,自1985年以来,超声、CT、MRI及DSA定位诊断阳性率逐渐提高,自2000年,EUS以最高的定位阳性率被认可,广泛应用.2008年,超声造影被尝试用于胰岛素瘤的定位,价值潜力很大.术前定位诊断方法多元化、简单化,术前定位价值逐渐提高.     

胰岛素瘤术前定位价值的探讨

目的：探讨胰岛素瘤的术前定位价值。方法：比较分析1985－2001年我院普外科收治的33例手术治疗胰岛素瘤患的各种检查定位方法，结果：各种检查的准确性如下：超声15％，普通CT33．3％，SCT62．5％，高场MR61．1％，选择性动脉造影46．1％，术中探查93．9％，术中超声91．7％，术中超声＋探查为100％。结论：术前定位检查的价值有限。     

胰岛素瘤术前定位价值的探讨

目的探讨胰岛素瘤的术前定位价值.方法比较分析1985 ～ 2001年我院普外科收治的33例手术治疗胰岛素瘤患者的各种检查定位方法.结果各种检查的准确性如下:超声15%,普通CT33.3%,SCT62.5%,高场MR61.1%,选择性动脉造影46.1%,术中探查93.9%,术中超声91.7%,术中超声+探查为100%.结论术前定位检查的价值有限.     

内镜超声检查在胰岛素瘤定位诊断中的价值

胰岛素瘤是常见的内分泌肿瘤 ,根据典型临床表现和血液生化检查可以定性诊断 ,手术为最佳治疗方法 ,术前正确的定位是治愈的前提 ,但是传统的影像学检查方法的定位诊断率仍较低。随着内镜超声 (EUS)技术的发展 ,近年也应用于胰岛素瘤的定位诊断 ,其诊断阳性率达 80 %～ 90 % [1 3 ] 。本研究通过比较EUS和腹部超声 (US)、螺旋CT、选择性腹腔动脉造影 (DSA)等不同定位方法的阳性诊断数 ,评价EUS在胰岛素瘤定位诊断中价值。一、资料和方法1 研究对象 :2 0 0 0年 4月～ 2 0 0 2年 8月共收集本院内分泌科住院的可疑胰岛素瘤患者 9例 ,其…     

31例胰岛素瘤临床及定位诊断分析

目的提高对胰岛素瘤的认识、诊断和治疗。方法对31例胰岛素瘤患者的临床资料和定位诊断进行总结分析。结果患者病程3周~14年,23例手术治疗,术后病理诊断为胰岛细胞瘤,其中2例多发内分泌腺瘤(MEN-1型)。8例未行手术治疗,经临床检查诊断为胰岛素瘤。31例中有28例有典型的Whipple三联症,住院期间低血糖发作,血糖在0.57~2.7mmol/L之间。23例INS(血浆胰岛素)/G(血糖)>0.3。影像学检查阳性率:超声检查为53.3%,CT为50%,血管造影(DSA)为78.9%,内镜超声(EUS)为91.6%。结论胰岛素瘤患者常反复发作低血糖、有各种交感神经兴奋及神经精神症状,影像学检查以EUS、DSA检出率为高。尤其EUS检查创伤小,阳性率高,应作为临床胰岛素瘤定位诊断的主要手段之一。     

胰岛素瘤术前定位分析——119例报告

目的 提高对胰岛素瘤术前定位诊断的准确率.方法 同顾性分析解放军总医院1985年1月至2008年4月入院的1 19例胰岛素瘤患者的临床资料.结果 全组病例共100例行手术治疗,98%(98/100)病例绛病理检查确诊为胰岛素瘤.术前各项定位检查的阳性率:B超22.9%(17/74),CT 55.2%(48/87),磁共振(MRI)58.8%(10/17),数字减影血管造影(DSA)76.6%(49/64),内镜超声(EUS)93.3%(42/45),超声造影(UC)94.7%(18/19).每项检查的准确率:B超88.2%(15/17),CT 87.5%(42/48),MRI 90.0%(9/10),DSA 100.0%(49/49),EUS 85.7%(36/42),UC 83.3%(15/18).术前有1～3项定位检查阳性,定位准确率分别为88.9%(24/27)、96.9%(32/33)及94.7%(18/19).手术组中,63例行CT和B超检查,阳性率47.6%(30/63);53例行CT和DSA检查,阳性率为75.5%(40/53);37例行CT和EUS检查,阳性率为89.2%(33/37);31例行EUS和DSA检查,阳性率为90.0%(28/31);14例行DSA和UC检查,阳性率为78.6%(11/14);13例行CT和UC检查,阳性率92.3%(12/13);11例行EUS和UC检查,阳性率90.9%(10/11).结论 术前有2项以上相符合的定位榆查,能大大提高胰岛素瘤术前定位诊断的准确率.以CT、DSA、EUS和UC中的两种组合阳性率较高.兼顾费用和检查的创伤,推荐采用CT、EUS和UC中的两种组合定位.     

彩色多普勒内镜超声在胰岛细胞瘤术前定位诊断中的作用

目的 探讨彩色内镜超声在胰岛细胞瘤术前定位诊断中的作用。方法 对经内科检查定性诊断为胰岛细胞瘤，并准备手术切除的7例患者，术前进行彩色多普勒内镜超声（ECDUS），经腹B超和胰腺螺旋CT增强扫描检查，并与手术和病理检查结果相对照，比较上述3种影像学检查在术前定位诊断中的作用。结果 7例患者手术和病理检查共发现10个病灶，ECDUS检出8个，胰腺螺旋CT增强扫描检出1个，经腹B超未有检出，病灶部位与手术见一致。ECDUS漏诊的2个病灶，直径均小于或等于0.5cm。检查中无并发症发生。结论 ECDUS对胰岛细胞瘤的术前定位诊断比B超，CT等无创性检查技术，敏感性高，定位准确，但对于直径小于或等于0.5cm的病灶，定位诊断仍有困难。     

A single-center experience on endoscopic ultrasonography-guided ethanol ablation of insulinomas

Background/objectivesAs the most frequent functional pancreatic neuroendocrine tumor, insulinomas may cause a plethora of symptoms and severe impairment in the living of patients by endogenous hyperinsulinemia and subsequent hypoglycemia. Surgery has been regarded as the first choice although a high risk of complications. Ethanol ablation is a promising non-surgical option that could achieve tumor shrinking in a short-term period. But the impact of symptom control and the long-term efficacy lack sufficient and good-quality evidence.MethodsA total number of 14 endoscopic ultrasonography-guided ethanol ablations were performed in 9 patients between September 2016 and September 2018 in Peking Union Medical College Hospital. The data were collected and prospectively analyzed.ResultsThe follow-up duration ranged from 21 to 1567 days in 9 patients, with a median of 994 days. 4 patients were free from relapse during a median follow-up of 1108 days (range: 994–1567 days). In 5 patients who suffered relapses, the median duration with symptom relief after the first ablation was 128 days (range: 13–393 days). If only repeated ablation was taken into consideration, the median duration with symptom relief was 26 days (range: 1–516 days). No complications happened during the procedures. The severe complication rate after the first ablation was 0.0% (0/9), compared to 7.14% (1/14) if each procedure was counted separately. The only severe complication documented was acute pancreatitis which was completely relieved after symptomatic treatment.ConclusionsFor patients who are not suitable for surgical resections, endoscopic ultrasonography-guided ethanol ablation of insulinomas could be an effective and safe alternative to relieve symptoms of hypoglycemia.     

低频小探头超声内镜对胰腺内分泌肿瘤术前定位诊断的价值

目的 评价低频小探头超声内镜检查(LFMPS)在胰腺内分泌肿瘤术前定位诊断中的临床价值。方法 2000年6月至2002年6月期间21例临床拟诊为胰腺内分泌肿瘤的患者术前行腹部 B超、螺旋 CT、磁共振(MRI)及 LFMPS探查(Fujinon 7.5 MHz低频小探头超声及超声系统),检查结果与外科术中定位和病理结果对照,评估LFMPS对胰腺内分泌肿瘤的术前定位诊断价值。结果21例患者中17例经外科手术及术后病理证实为内分泌肿瘤,4例未手术。其中胰岛素瘤16例(头部9例、体部 3例、尾部4例),胰腺外血管活性肠肽瘤1例,检出病灶的平均直径 2.02 cm。LFMPS确诊14例(82.4％),B超确诊9例(52.9％),螺旋CT确诊15例(88.2％),MRI确诊12例(70.6％),其中LFMPS对位于胰腺头、体部肿瘤以及直径<1cm病灶的确诊率优于其他常规影像方法。结论LFMPS对胰腺内分泌肿瘤的术前定位诊断准确率较高,且与肿瘤的位置与大小有关。     

Endoscopic ultrasonography for preoperative diagnosis and localization of insulinomas

BACKGROUND: Endoscopic ultrasonography (EUS) is generally accepted as a sensitive method for the detection of small pancreatic tumors. We report our experience with EUS for preoperative imaging of insulinomas. METHODS: Nine patients with clinical and biochemical signs of insulinoma were examined by EUS using a 7.5/12 MHz radial-scanning ultrasound endoscope prior to surgery. EUS outcome was evaluated on the basis of surgery (open or laparoscopic) and examination of the resected specimens. RESULTS: Two EUS-negative patients appeared, by reassessment of clinical and biochemical data, not to have an insulinoma and were not operated on. EUS correctly imaged and localized five of seven insulinomas that were surgically removed. One isoechoic tumor in the pancreatic head and one pedunculated tumor connected to the caudal side of the pancreatic body were missed by EUS. EUS could demonstrate the size and shape of the imaged tumors, as well as their relationship to adjacent structures, such as the pancreatic duct, bile duct, and large vessels. CONCLUSIONS: Our experience with seven insulinomas accords with previous reports claiming EUS to be the method of choice for preoperative imaging and localization of pancreatic islet cell tumors.     

Role of intraoperative ultrasonography in the surgical management of insulinomas

The findings in 35 surgically treated patients with insulinoma and 43 tumors of these patients were analyzed to confirm the efficacy of diagnostic modalities and surgical interventions. The rate of accurate preoperative tumor localization was 72% by angiography, 53% by computed tomographic scan, 55% by ultrasonography, and 83% by percutaneous transhepatic portal vein sampling. Extensive operative exposure and palpation detected 81% of the tumors and intraoperative ultrasonography demonstrated 96% of the tumors. Intraoperative ultrasonography was significantly better than any other diagnostic procedure and was able to demonstrate the anatomical relationship of the insulinoma to the essential structures of the pancreas. Intraoperative ultrasonography also helped determine the safest route for enucleating the insulinomas. Five patients (14%) in our series had metastatic diseases; 2 of these patients with metastases beyond the lymph nodes died due to the growth of tumors. The other 33 patients were free of insulinoma syndrome after the removal of the insulinomas. Streptozotocin was used in 1 patient with recurrent malignant insulinoma, with encouraging results.