Transhepatic portal vein catheterization for localization of insulinomas: a ten-year experience.

摘要: One of the most important factors in management insulinomas is ability to localize tumor accurately either before or during surgery. We prospectively carried out transhepatic portal venous sampling (THPVS) for localization 35 40 patients with organic hyperinsulinism a 10-year period. In 32 who underwent THPVS and whom single was subsequently identified surgically, maximal insulin gradient located vicinity 100% cases. Specific regionalization on basis site one three regions (the tail, body/neck region, head/uncinate region) gave sensitivity 81% specificity 91%. contrast, use specific cutoff levels as guide presence these did not increase accuracy, leading instead significant loss no comparable specificity. There were major complications from procedure any patient. The initial computed tomographic/ultrasound scanning selective angiography localized only 46% tumors, whereas subsequent led accurate preoperative all tumors submitted Although surgeon would have correctly at operation, 19% (n = 6) he failed. Four uncinate two head. It seems that proved established hyperinsulinism, may continue be value, if regionalize tumor, especially those pancreatic head process so preclude noncurative operations body tail pancreas.