@article{oai:toyama.repo.nii.ac.jp:00002356,
 author = {黒崎, 功 and 佐藤, 好信 and 大竹, 雅広 and 青野, 高志 and 宗岡, 克樹 and 塚田, 一博 and 畠山, 勝義},
 issue = {2},
 journal = {日本消化器外科学会雑誌 : The Japanese journal of gastroenterological surgery},
 month = {Feb},
 note = {application/pdf, インスリノーマの外科治療に関しては, 常に腫瘍の多発性を念頭において, 腫瘍を摘出する事とその確認が重要である.過去11年間に新潟大学第1外科にて切除された膵のインスリノーマ症例8例(含11病変)を対象に, 術前画像診断およびpercutaneous transhepatic portal vein sampling(以下, PTPVSとする)による腫瘍の局在診断, 術中における腫瘍完全摘出度の判定について検討した.術前画像診断による腫瘍の局在診断は血管造影検査で65%, CTおよび超音波検査はおのおの55.5%であった.PTPVSによる局在診断は81.8%であった.腫瘍摘出前後の血糖値の推移のみでは1例で完全摘出が確認できなかったが, 最近の症例では腫瘍摘出時の血糖測定に門脈血中のIRIを測定することで完全摘出の確認が容易となった.全例で低血糖発作の再現や腫瘍の再発は認められず, 術中の局在診断, 腫瘍の完全摘出の判定は適切と思われた.
 Eight patients with a total of 11 insulinomas were examined by ultrasonography (US), computed tomography (CT), angiography, and percutaneous transhepatic portal vein sampling (PTPVS) preoperatively.We discussed preoperative diagnostic accuracy and intraoperative localization.Tumor localization was achieved by US in 55.5%, CT in 55.5%, and angiography in 65%.Three patients underwent tumor extirpation, and 4 distal pancreatectomy.One patient received extirpation and distal pancreatectomy.The surgical strategy for insulinoma is complete resection of the tumor, so not only exact pre- and intra- operative localization but also certification of comlete removal of the tumor are important.After excision of the insulinoma most patients exhibited a definite early hyperglycemic rebound but intraoperative IRI monitoring of the portal vein was useful for confirmation of tumor excision.All the patients were alive without hypoglycemia or tumor recurrence.The incidence of patients with multiple tumors and malignancy was 25% (2/8) and 12.5% (1/8) respectively., Article},
 pages = {150--154},
 title = {インスリノーマの術中局在診断},
 volume = {34},
 year = {2001}
}