SUCCESSFUL DIAGNOSIS OF LOCALIZATION OF INSULINOMA BY OPERATIVE ECHOGRAPHY, -A CASE REPORT

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  • SUDO Takaaki
    The Second Department of Surgery, Kinki University School of Medicine
  • TAKEMOTO Masahiko
    The Second Department of Surgery, Kinki University School of Medicine
  • KASAHARA Yoh
    The Second Department of Surgery, Kinki University School of Medicine
  • UEDA Shozo
    The Second Department of Surgery, Kinki University School of Medicine
  • SHOBU Ryuji
    The Second Department of Surgery, Kinki University School of Medicine
  • NAKAO Kiichi
    The Second Department of Surgery, Kinki University School of Medicine
  • KAWAMURA Masao
    The Second Department of Surgery, Kinki University School of Medicine
  • UMEMURA Hiroya
    The Second Department of Surgery, Kinki University School of Medicine
  • SHIRAHA Sei
    The Second Department of Surgery, Kinki University School of Medicine
  • KUYAMA Takashi
    The Second Department of Surgery, Kinki University School of Medicine
  • AOKI Norihiko
    The Second Department of Surgery, Kinki University School of Medicine Second internal Medicine, Kinki University School of Medicine
  • TSUJIMURA Daijiro
    The Second Department of Surgery, Kinki University School of Medicine Second internal Medicine, Kinki University School of Medicine
  • UESAWA Kumi
    The Second Department of Surgery, Kinki University School of Medicine Second internal Medicine, Kinki University School of Medicine
  • SUZUKI Tsuneyuki
    The Second Department of Surgery, Kinki University School of Medicine First Department of pathology, Kinki University School of Medicine

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  • 術中エコーにて局在を診断しえたインスリノーマの1例

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Abstract

インスリノーマは, 1-2cm以下の小さなものでも著明な低血糖発作を起し,臨床症状がそろっていても,いざ手術となると局在診断をしえない事がある.血管撮影, CT,術前エコー等の画像診断ならびに経皮経肝門脈採血法があり,経皮経肝門脈採血法は,かなりの実績をあげているが,腫瘍の大きさ,数の診断は不可能であり,いま一歩という感をまぬがれない.<br> 最近私達は,術中エコーにて膵体部に1.3×1.0×0.8cm大のインスリノーマを確認し,膵体尾部切除術にて治癒せしめえた症例を経験したので報告する.症例は,低血糖発作を主訴とする58歳男子で,昭和56年8月頃より空腹時に心悸亢進と頭痛を感じていた.昭和57年9月頃,朝食をとらずに眠っていて意識を消失し,某病院内科へ紹介された. CT,血管撮影,術前エコー,経皮門脈採血によるインスリン濃度を測定し,局在部位は推測されたが,確認はえられなかった.昭和59年1月9日,術中エコーにて膵体部にインスリノーマを確認し,膵体尾部切除術を施行した.

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