부산대학교 도서관

Background: Although the need for routine preoperative localization of insulinoma is challenged, accurate preoperative localization is regarded as the prerequisite for successful laparoscopic resection of insulinoma. Intra-arterial calcium stimulation with hepatic venous sampling for insulin gradients (ASVS) has been reported to be the most sensitive preoperative localization technique. The authors' experience with ASVS to localize and guide management of insulinomas is reviewed. Methods: Between 1991 and 1999, 20 patients underwent surgical resection for insulinomas. Sixteen patients (11 men, five women; median age 43 years) underwent ASVS for preoperative localization of insulinoma based on equivocal standard imaging studies. Intraoperative ultrasonography was performed routinely. The accuracy of ASVS was compared with that of intraoperative findings and other methods of localization. Results: There was no complication arising from the procedure. A median step-up of tenfold (right 3–37-fold; left 3–72-fold) in insulin level 30–60 s after injection to at least one feeding artery was observed in 14 patients. Enucleation and distal resection were performed in six and ten patients respectively. In the era of laparoscopy, open enucleation and laparoscopic resection were adopted for two tumours each located at the pancreatic head and tail respectively. Twelve of the 14 solitary tumours were located correctly; all four at the head, one of three in the body and all seven at the tail. Two patients with multiple endocrine neoplasia type 1 and multiple tumours had the dominant tumours located at the tail. The overall accuracy of this test was 88 per cent compared with 11, 31, 43 and 67 per cent for ultrasonography, computed tomography, magnetic resonance imaging and endoscopic ultrasonography respectively. Intraoperative ultrasonography readily located two tumours missed by ASVS which, in turn, guided the removal of a tumour located at the sple... [ABSTRACT FROM AUTHOR]