[ppt模板]低血糖(編輯修改稿)
2025-04-18 00:19 本頁面
【文章內(nèi)容簡介】 nsitivities are up to ? % at best with the use of digital subtraction angiography but reach 100% when bined with intraarterial calcium stimulation test ? The latter depends on the functional status of the tumor and has replaced the more hazardous procedure of percutaneous transhepatic venous sampling. 2022521 19 鈣刺激試驗(yàn) ? This was modified by Doppman et al. with the use of calcium for detection of insulinoma. ? In vitro studies show that a high extracellular calcium concentration invokes a rapid elevation of intracellular calcium concentration and almost instantaneous increase in insulin release in insulinoma cells, regardless of the glucose level— a finding not seen in normal b cell lines ? During arterialstimulated venous sampling, calcium gluconate is injected to each selectively cannulated artery, namely the gastroduodenal, superior mesenteric, splenic, and hepatic arteries. Venous samples for insulin are obtained from the right hepatic vein at baseline and serially up to 3 minutes after calcium injection. ? A positive test result, defined as a rise of twofold or more in immunoreactive insulin level from baseline , is indicative of a functional insulinoma in the vascular territory of the selected artery 2022521 20 2022521 21 內(nèi)鏡超聲 ? Endoscopic ultrasonography is one of the major breakthroughs in the last decade and has been remended to be the investigation of choice . ? Using an ultrasound probe with a frequency of 5 to MHz, high resolution images of the pancreas can be obtained, with insulinomas mostly appearing as welldefined, slightly hypoechoic areas within the pancreatic parenchyma . ? The reported sensitivity is encouraging, reaching up to 93% , although this falls to only 37% as one moves from the head of the pancreas to the tail , and even lower for pedunculated tumors . ? Fortunately, pedunculated and pancreatic tail tumors are the easiest to detect intraoperatively. 2022521 22 ERCP ? The use of endoscopic retrograde cholangiopancreatography with
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