摘要
目的提高对胰岛素瘤术前定位诊断的准确率。方法回顾性分析解放军总医院1985年1月至2008年4月入院的119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）病例经病理榆查确诊为胰岛素瘤。术前各项定位检查的阳性率：B超22．9％（17／74），CT55．2％（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），CT87．5％（42／48），MRI90．0％（9／10），DSA100．0％（49／49），EUS85．7％（36／42），UC83．3％（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检查，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。
Objective To improve the positivity for insulinoma localization by imaging before surgery. Methods The clinical data of 119 patients with insulinoma who had been admitted to Chinese PLA General Hospital from January 1985 to April 2008 were retrospectively reviewed. Results One hundred patients with hypoglycemia who had been operated and most of them （98/100） diagnosed as insulinoma pathologically were analyzed. They had undergone various methods of localization by imaging before surgery. The positive rates for tumor localization were 22.9% （ 17/74 ） by uhrasonography （ US ） , 55.2% （ 48/87 ） by CT, 58.8% （ 10/17 ） by MRI, 76.6% （49/64） by digital subtraction angiography （ DSA ） , 93.3 % （ 42/45 ） by endoscopic uhrasonography （ EUS ） and 94.7% （18/19） by ultrasonic contrast （UC）. While the rates of accuracy for tumor localization were 88.2% （ 15/17 ） by US,87.5% （42/48） by CT, 90.0% （9/10） by MRI, 100.0% （49/49） by DSA, 85.7% （ 36/42 ） by EUS and 83.3% （15/18） by UC. The rates of accuracy in patients with one,two and three positive images were 88.9% （24/27）, 96. 9% （ 32/33 ） and 94. 7% （ 18/19 ） , respectively. The positive rates in patients with combination of two images were 47.6% （ 30/63 ） by CT and US,75.5 % （40/53） by CT and DSA, 89.2% （ 33/37 ） by CT and EUS,90.0% （27/30）by EUS and DSA,78.6% （11/14）by DSA and UC,92.3% （12/13）by CT and UC,and 90.9% （ 10/11 ）hy EUS and UC,respectively. Conclusion The positive rates and accuracy of localization for insulinoma were increased by comhining at least two images, and the combinations of any two of four images including CT,DSA, EUS and UC are suggested. While considering both the cost and effect, we recommend CT combined either with EUS or UC.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2009年第3期291-294,共4页
Chinese Journal of Endocrinology and Metabolism
