超声内镜弹性成像在超声内镜引导下细针注射术治疗胰岛素瘤疗效评估中的应用

Application of endoscopic ultrasound elastography to the evaluation of endoscopic ultrasound‑guided fine needle injection for insulinoma

摘要:

目的 探讨超声内镜弹性成像在超声内镜引导下细针注射术（endoscopic ultrasound‑guided fine needle injection，EUS‑FNI）治疗胰岛素瘤疗效评估中的应用价值。方法 回顾性分析2016年4月—2021年3月在广西医科大学第一附属医院消化内镜中心确诊为胰岛素瘤且行EUS‑FNI治疗的21例患者的临床资料，部分患者治疗前后行超声内镜弹性成像检查。统计分析治疗前后最低血糖、同步胰岛素、同步C肽、弹性成像颜色模式、弹性评分、a‑弹性值、应变比等数据变化。结果 21例患者中男5例、女16例，共计24处病灶，瘤体内共注射39次，8例为单次注射，13例为重复注射。术后患者症状改善，最低血糖不同程度升高，与术前比较差异有统计学意义［2.59（1.95，3.82）mmol/L比1.50（1.00，2.00）mmol/L，Z=-4.278，P<0.001］，同步胰岛素［96.69（44.80，249.30）pmol/L比159.10（100.30，373.70）pmol/L，Z=-1.445，P=0.148］、C肽［3.56（2.98，8.05）ng/mL比6.16（3.74，11.47）ng/mL，Z=-1.825，P=0.068］水平下降，但与术前比较差异无统计学意义。术前16例行弹性成像检查，弹性评分为2.00（2.00，3.00），术后15例行弹性成像检查，弹性评分为5.00（5.00，5.00）。15例记录了术前a‑弹性值，为0.16（0.08，0.30），12例记录了术后a‑弹性值，为0.07（0.05，0.18）。14例记录了术前弹性应变比，为2.28（1.67，4.38），12例记录了术后弹性应变比，为5.16（2.08，8.17）。与术前比较，术后弹性评分增大（Z=-4.694，P<0.001），a‑弹性减小（Z=-2.099，P=0.036），应变比差异无统计学意义（Z=-1.492，P=0.136）。术后胰岛素瘤病灶变硬，弹性成像颜色模式由以绿色为主逐渐转变为以蓝色为主。21例患者术中及术后均无腹痛、发热、胰腺炎等并发症发生。结论 EUS‑FNI治疗胰岛素瘤安全有效。超声内镜弹性成像作为该手术疗效评估的一种新手段，可评估病灶消融程度，指导注射治疗。

Abstract:

Objective To apply endoscopic ultrasound (EUS) elastography to the evaluation of EUS‑guided fine needle injection (EUS‑FNI) for insulinoma. Methods Clinical data of 21 patients with insulinoma who were treated with EUS-FNI at the digestive endoscopy center of the First Affiliated Hospital of Guangxi Medical University from April 2016 to March 2021 were collected. Some patients underwent EUS real-time elastography before and after the treatment. The minimum blood glucose, synchronous insulin, synchronous C peptide, elastic imaging color pattern, elastic score, a-elasticity, elastic imaging strain rate before and after the treatment were analyzed. Results Among the 21 cases with 24 lesions, there were 5 males and 16 females. There were totally 39 times of injection, where 8 cases underwent single injection, and 13 cases repeated injection. After the operation, patients'' symptoms improved, the minimum blood glucose increased in different degree [2.59 (1.95, 3.82) mmol/L VS 1.50 (1.00, 2.00) mmol/L, Z=-4.278, P<0.001], the level of synchronous insulin [96.69 (44.80, 249.30) pmol/L VS 159.10 (100.30, 373.70) pmol/L, Z=-1.445, P=0.148] and C peptide [3.56 (2.98, 8.05) ng/mL VS 6.16 (3.74, 11.47) ng/mL, Z=-1.825, P=0.068] decreased, but no statistical difference compared with those before the operation. Sixteen cases underwent preoperative endoscopic elastography, with elastic score of 2.00 (2.00, 3.00), and 15 cases underwent postoperative elastography with elastic score of 5.00 (5.00, 5.00). Preoperative a-elasticity was recorded in 15 cases with value of 0.16 (0.08, 0.30), and postoperative a‑elasticity was recorded in 12 cases with value of 0.07 (0.05, 0.18). The preoperative strain rate were recorded in 14 cases with 2.28 (1.67, 4.38), and postoperative strain rate were recorded in 12 cases with 5.16 (2.08, 8.17). Compared with those before the operation, the postoperative elastic score increased (Z=-4.694, P<0.001), the a-elasticity decreased (Z=-2.099, P=0.036), and the difference in strain ratio was not statistically significant (Z=-1.492, P=0.136). Meanwhile, the lesions of insulinoma became harder, the elastic imaging mode changed from green to blue. There were no complications such as abdominal pain, fever, or pancreatitis during and after the operation. Conclusion EUS-FNI is safe and effective for the treatment of insulinoma. Endoscopic elastography, as a new means to evaluate the efficacy of the operation, can be used to evaluate lesion ablation and guide injection therapy.