The role of intra-arterial calcium stimulation test with hepatic venous sampling (IACS) in the management of occult insulinomas
The role of intra-arterial calcium stimulation test with hepatic venous sampling (IACS) in the management of occult insulinomas
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DOI：
10.1245/s10434-007-9398-4
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发表时间：
2007-07-01
影响因子：
3.7
通讯作者：
Lee, Chen-Hsen
中科院分区：
文献类型：
--
作者：
Tseng, Ling-Ming;Chen, Jui-Yu;Lee, Chen-Hsen
背景：隐匿性胰岛素瘤仍然是一个临床挑战。专门设计的协议是必要的，以帮助检测和促进重点pancreatic exploration.Methods：17非多发性内分泌瘤（非MEN）患者提到这个医疗中心在过去的10年中，因为模棱两可的诊断，以前的操作失败或定位胰岛素瘤的困难进行了研究。常规动脉内钙刺激试验（IACS试验）进行病变定位。术中超声（IOUS）examinations.Results：术前成像（超声，高分辨率计算机断层扫描，磁共振成像）发现6个胰岛素瘤，和IOUS发现另外6个在胰腺区域，所有兼容的IACS测试表明。其余5例IOUS显示隐匿性病变的患者分别接受了40%（1）或60-70%（4）的远端胰腺切除术治疗，此时钙刺激脾动脉或上级肠系膜动脉显示胰岛素梯度，并且每次病理检查均发现胰岛母细胞增多症。没有出现与动脉刺激和静脉采样（ASVS）测试相关的并发症。没有患者复发性高胰岛素血症，永久性发病率，或死亡率从surgery.Conclusions：IACS测试有助于在可疑的胰源性低血糖症的诊断，表明胰腺区域的优先勘探和指导胰腺切除术。
Background: Occult insulinomas remain a clinical challenge. Specifically designed protocols are necessary to aid detection and facilitate a focused pancreatic exploration.Methods: Seventeen non-multiple endocrine neoplasia (non-MEN) patients referred to this medical center in the past 10 years because of equivocal diagnosis, failure of previous operation or difficulty in localization for insulinomas were studied. A routine intra-arterial calcium stimulation test with venous sampling (IACS test) was done for lesion localization. An exploratory laparotomy with intraoperative ultrasound (IOUS) examinations was performed.Results: Preoperative imaging (sonography, high-resolution computed tomography scan, and magnetic resonance imaging) found six insulinomas, and IOUS found an additional six in the pancreatic regions; all were compatibly indicated by the IACS test. The remaining five patients with occult lesions by IOUS were treated by 40% (1) or 60-70% (4) distal pancreatectomies when insulin gradients were demonstrated on calcium stimulation to the splenic or to the superior mesenteric artery, respectively, and nesidioblastosis was found in each pathology examination. There were no complications related to the arterial stimulation and venous sampling (ASVS) test. No patient had recurrent hyperinsulinism, permanent morbidity, or mortality from surgery.Conclusions: IACS test helps in the diagnosis of equivocal pancreatogenous hypoglycemia, indicating the pancreatic region of priority exploration and guiding a pancreatic resection.