Intraoperative ultrasound and preoperative localization detects all occult insulinomas
Intraoperative ultrasound and preoperative localization detects all occult insulinomas
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DOI：
10.1001/archsurg.136.9.1020
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发表时间：
2001-09-01
影响因子：
--
通讯作者：
Norton, JA
中科院分区：
文献类型：
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作者：
Hiramoto, JS;Feldstein, VA;Norton, JA
假设：当非侵入性成像研究结果不明确或阴性时，术前侵入性定位程序与术中超声（IOUS）可以成功手术治疗隐匿性胰岛素瘤。设计：前瞻性研究。设置：三级护理大学医院。患者：37例连续的胰岛素瘤生化诊断患者，无多发性内分泌腺瘤（MEN）。干预：所有患者均接受门静脉取样（PVS）（n = 22）或钙血管造影（n = 15），然后手术触诊和IOUS（n = 37）。主要结果测量：比较门静脉取样、钙血管造影、触诊和IOUS对胰岛素瘤的准确定位。所有患者术后低血糖均治愈。22例患者中，17例（77%）门静脉取样正确定位肿瘤。15例患者中13例（87%）钙血管造影正确。姑息治疗发现了37个肿瘤中的24个（65%），IOUS发现了37个肿瘤中的35个（95%）。IOUS漏诊的2例肿瘤均位于胰尾，仅根据区域定位进行了切除。结论：术中超声是唯一最好的定位研究，但它会漏诊一些区域定位可以识别的肿瘤。在我们的研究中，结合两种方式可以手术治愈所有胰岛素瘤。因此，当术前影像学检查不明确时，我们建议对胰岛素瘤进行IOUS和区域定位。
Hypothesis: Preoperative invasive localization procedures with intraoperative ultrasound (IOUS) can result in successful surgical treatment of occult insulinomas when noninvasive imaging study results are equivocal or negative.Design: Prospective study.Setting: Tertiary care university hospital.Patients: Thirty-seven consecutive patients with a biochemical diagnosis of insulinoma without multiple endocrine neoplasia (MEN).Intervention: All patients underwent portal venous sampling (PVS) (n = 22) or calcium angiogram (n = 15) followed by surgery with palpation and IOUS (n=37).Main Outcome Measure: Portal venous sampling, calcium angiogram, palpation, and IOUS were compared for accurate localization of insulinoma.Results: All patients were cured of hypoglycemia after surgery. Portal venous sampling correctly localized tumors in 17 (77%) of 22 patients. Calcium angiogram was correct in 13 (87%) of 15 patients. Palliation identified 24 (65%) of 37 tumors, and IOUS found 35 (95%) of 37 tumors. The 2 tumors missed by IOUS were located in the tail of the pancreas and were resected based on regional localization alone,Conclusions: Intraoperative ultrasound is the single best localization study, but it will miss some tumors that regional localization can identify. Combining both modalities allowed surgical cure of all insulinomas in our study. Therefore, we recommend both IOUS and regional localization for insulinoma when preoperative imaging studies are equivocal.