搜索
JSurgConceptsPract200534o567089o:;··!,!,!,!,!,,#,!(a.,b.,c.,200025)():(=S)、(?S)、C、@A、(S=B)(=S4S)(P?)。:C5P?,P?,P?。::=S;D:;E;7:5E,?SF0:0ED5:0E,CGC:FEG2:GE,@AG5:DEDD:;E,S=B7C:DE7C:DE=S4SGH:HEGH:HE。:P?,=S、@SC@A;,?S=S4S;。:;,I;;,:ADH5:F:=:700D!FC70J2005K0;!0HC;!0CThehoieofpreoperativeloalizationproeduresofpanreatiendorinetumorsS#$%&’()*#$+,-!.&’-/’(0*#1&!2’&’(+34’!5&-/’(16*#$67’’896:#;&(163%&=(96:#,!5&-’?’@4,A’BC5,-CDEF’G&D2D/H8@4,A’BC5,-CDES7B/,BH,=@4,A’BC5,-CDE$’ICBD,-C,BD2D/H8F7&J&-6DIA&C’28SK’-/K’&S,=D-GL,G&=’23-&M&I&CH8SK’-/K’&NOPPNQR9K&-’[Abstrat]ObjetiveostuLMtNere5atOPePa5ueoQtransaRLoSOna5u5trasounLJ=SK3enLoscopOcu5trasounLJ?SK3C3@A3se5ectOPeangOograpNMJS=BK3anLOntraarterOa5ca5cOuSstOSn5atOonJ=S4SKQorpreoperatOPe5oca5OTatOonoQpancreatOcenLocrOnetuSorsJP?K:MethodsUataoQpreoperatOPeOSagOngtecNnOVuesapp5OeLOnC5patOentsWOtNsurgOca55ManLpatNo5ogOca55MconQOrSeLP?sWereretrospectOPe5Mana5MTeL:ResultsNesensOtOPOtManLaccuracMQorpreoperatOPeapp5OcatOonoQeacNXOnLoQtNeproceLuresWere;D:;YanL;7:5EOn=SZF0:0EanLD5:0EOn?SZGC:FEanLG2:GEOnCZG5:DEanLDD:;EOn@AZ7C:DEanL7C:DEOnS=BanLGH:HEanLGH:HEOn=S4SrespectOPe5M:Conlusions?acNe[aSOnatOonNasOtsaLPantageanLLOsaLPantage:?asOernon!OnPasOPetecNnOVues3sucNas=S3Cor@AsNou5LReconsOLereLQOrstZOQtNeMturnouttoRenegatOPe3?Sor=S4Scou5LReconsOLereL:SurgOca5e[p5oratOonanL\orOntra!operatOPeSreSaOntNeQOna5resorts:Keywords:PancreatOcenLocrOnetuSorZSonograpNMZCZ@AZ]nterPentOona5raLOo5ogM(pancreatOcenLocrOnetuSor3P?),7E2E^782_,5\^H_。P?,P?、,。‘、(?S)、C、@A(=S4S)P?,C,P?。、7FFF7200;72C5P?,2;,;7,7HDH,;;:7;2H0,C:5。57aNOpp5e,7(]\B)b0:H;2,,(b700pg\S5);7,;7、、$%&!!2005104、VIP;10,。、65BCT,24EUS,31MR,12ASVS(SAG),B,EUS、CT、MR,ASVS。1.:Logic-9(GE),3.5MHz;(HiSpeedAdvantage)4(GELightSpeedQX/i)CTGE;EG410D、SP-7017.5MHzFujinon;1.5TSigna/MRILCVGE。2.:8h。(1)B:,,,,。(2)EUS:10%,10min5mg10mg。,,、,、、、。(3)CT:30min1000ml。,、10mm,(2ml/kg,300mgI/ml)(2.5～4.0ml/s),()(、),20～25s,30～40s,60～90s。,,2.5～5.0mm,1.0～1.2,1.5～2.5mm;,5mm,1.5,。(SSD)(MIP),(MPVR)。(4)MR:(TORSO),SET1W(TR400,TE20);(FSE)T2W(TR6315,TE105);T1W(TR700,TE9),5mm,1mm,256×192,340mm×340mm,4。(FSPGR)(TR150,TE3),(Gd-DTPA)20ml,2ml/s,20、40、70s,、。(5)ASVS:5%250ml。(DSA),Seldinger,,(GDA)、(SMA)、(SAP)(SAD),,,,,10%3ml。0s、30、60、90、120、150180s1ml,15min。,。、PET(sensitivity,SN)(accuracy,AC),=/(+),=(+)/,,,。、CT,65,64(66,22),48(46、11),(MENⅠ)2,2,1,1,9,11。63,(n=8)、(n=12)、(n=8)、(n=18)(n=17);2,1。1。、1,2。365!!JSurgConceptsPract200534o567089o:;、7.:2=,(20)、(7)、4P(7)P?@(5),,,,。74P。2.?AS:7B。、、,。C.C@:!:,22,;5,;:(nDE0)(7F),7,5。EE(7=GEE,256BH)(7F)、(70GEE,75:2H)(2F)(CIGEE,5I:7H)(CF、C)C,(2BGEE,;2:;H)、(20GEE,C0:CH)(7BGEE,2=:CH)C。;.JK:C7JK2;,:!@7L:7E,B,;@2L:7;,B,2;#@7L:,2C,(7、2),7;$MSP-NK:75MSPNK5,70。I,;5,;7,。70,;,7。5.SFN:72FS4S,NOF、SJF(SPF),2,SJF,760cP765cP。E.FS4S:72FS4S,NOF、SJF、SFPSFO;(nDE5)?AS(nD2;)C@(nDE5)JK(nDC7)SFN(nD72)FS4S(nD72)()2=607B605C602;602607060()B60;60;60C60060060()C060260B60;607060260QHR;=:;I0:0BE:IB5:=7E:=BC:CQHR;7:5=5:0B7:5==:;7E:=BC:C12(cP)@FAS;E;=E7:0～=:02:;2?AS2=2520:B～2:07:CEC@;7757;7I0:E～=:07:BBJK2=2E=0:B～;:57:;BSFN020007:0～7:57:25FS4SC;072－－(),C7,2,C@,(F),JK@7L()1F366!!2005104(1SAD,1),,(0s),,2(2),(3D)。GDA、SMA、SAPSAD、、。、,80%～85%PET,,[4]。,。90%PET≤2cm,1.53cm。PET,80%、,,5%PET(multipleendocrineneoplasia,MEN),2%PET,20%,。4846,1,1,、,21,2、MENⅠ,[4]。PET,,,,,,PET4.76cm。,PET,()CT(A)MR(B),ASVS(C),2ABC(uIU/ml)ASVS1201008060402000306090120150180(s)SAPSADGDASMA(A),(B),,,CT(C),ASVSSMA,PHA,,,(D)3MEN!BA(uIU/ml)ASVS0306090120150180(s)SAPSADPHAGDASMAD150010005000C367!!JSurgConceptsPract200534o567089o:;(),;P=。、,,,?0@,;A:;@。P=,。C=、BC,、,,,P=,P=。、DSDS,7:0cE(0:5cE),,,。DSF0@,7:0cEG58?H。DS、,,,DS,,,DS。DSP=,,C=、BC。DS0:IcE,7:J?cE,,、,F;:7@(7?K7A),2I:?@(2KA)。、C=P=≤2cE,,,,,,,,GA～70H。5;P=,;F,5。P=。P=,5cE,P=,、,GFH。FP=I,、、。C=I7:5@,LS4S,0:?cE,DS。、BCP=S,,。=7M,,,G77～7JH。=7M=2M57:?@(7?KJ7),,=7MA;:2@(2JKJ7)。,75NSPOC,FJ6J@(7;K75),BC06IcE,76;IcE,DS。NSPOC,,,,P=。BC,=7MC=、,BC。7C=,BC=7M(7L、)。、LS4SPoppEanG7;HLS4S,2000J?LS4S,F;@,(=LDS7J@,C=2;@,BC2;65@,SLO;J@)G75H。G7?HFJ6A@,F0@G7A87IH。OPL、SBLSPL,,;SBL;SPL。IJ6J@,,,706IcE,C=,DSBC,LS4S,。LS4S,7C=、BC368!!2005104,,,ASVS,(2A-C)。ASVS,1(MENⅠ),1,,,ASVS,,(3A-D)。ASVS,,ASVS,,。、PETPET,,,B,CT,(CT),,,。B、CTCT,MREUS,MRCT,EUS。,,ASVS。[][1]KloppleG,HeitzPU.Pancreaticendocrinetumors[J].PatholResPract,1988,183:155-168.[2]BuetowPC,MillerDL,ParrinoTV,etal.Isletcelltu-morsofthepancrease:clinical,radiologicandpathologiccorrelationindiagnosisandlocalization[J].Radiograph-ics,1997,17(2):453-472.[3]SheilaS,RalphKH,ElliotKF.HelicalCTofIsletcelltumorsofthepancreas:typicalandatypicalmanifesta-tions[J].AJR,2002,179(3):725-730.[4],.[J].:,2002,954-957.[5]GouyaH,VignauxO,AuguiJ,etal.CT,endoscopicsonography,andacombinedprotocolforpreoperativee-valuationofpancreaticinsulinomas[J].AJR,2003,181(4):987-92.[6]AndersonMA,CarpenterS,ThompsonNW,etal.Endo-scopicultrasoundishighlyaccurateanddirectsmanage-mentinpatientswithneuroendocrinetumorsofthepan-creas[J].AmJGastroenterol,2000,95(9):2271-2277.[7]HoeLV,GryspeerdtS,MarchalG,etal.HelicalCTforthepreoper