Kaneko T, Nakao A, Inoue S, Sugimoto H, Hatsuno T, Ito A, Hirooka Y, Nagasaka T, Nakashima N
Department of Surgery II, Faculty of Medicine, University of Nagoya, Nagoya, Japan.
Surgery. 2001 Jan;129(1):55-65. doi: 10.1067/msy.2001.109118.
Intraductal papillary mucinous tumors of the pancreas (IPMT) spread along the main pancreatic duct (MPD) or branch duct, or both. It is important to intraoperatively determine the extent of IPMT lesions in the MPD to perform a successful operation.
This study included 27 consecutive patients with IPMT who were referred for operation and who had undergone endoscopic ultrasonography, endoscopic retrograde pancreatography, and computed tomography as a diagnostic examination. Intraoperative ultrasonography with a 7.5-MHz annular array transducer and a 7. 5-MHz conventional transducer was performed. All patients underwent operation, and the pathology was confirmed. Endoscopic ultrasonography, endoscopic retrograde pancreatography, intraoperative conventional ultrasonography, and intraoperative annular array ultrasonography results were correlated with those from a pathologic examination of the resected specimens. The diagnostic accuracy of these 4 modalities in the detection of IPMT lesions in the MPD and the branch duct was confirmed.
The diagnostic criterion of IPMT lesions by intraoperative annular array ultrasonography was the presence of echogenic masses with irregular margins in the MPD or branch duct, or both. An IPMT lesion in the MPD was found in 22 of the 27 patients. Intraoperative annular array ultrasonography detected 5 cases of IPMT lesions in the MPD that could not be detected by endoscopic ultrasonography or endoscopic retrograde pancreatography. In 3 of 5 patients, pancreatic resection was extended to remove IPMT lesions. Intraoperative annular array ultrasonography detected 3 multifocal lesions that could not be detected by preoperative examinations. For the diagnosis of IPMT lesions in the MPD, the respective sensitivity, specificity, and overall accuracy of intraoperative annular array ultrasonography were 86%, 100%, and 89%; the respective values were 50%, 100%, and 59% for endoscopic retrograde pancreatography; 59%, 100%, and 67% for endoscopic ultrasonography, and 32%, 100%, and 44% for intraoperative conventional ultrasonography. For the diagnosis of IPMT lesions in the branch duct, the respective sensitivity, specificity, and overall accuracy of intraoperative annular array ultrasonography were 95%, 100%, and 96%.
Intraoperative annular array ultrasonography is suitable for longitudinal scanning of the MPD, useful for accurate diagnosis of the extent of IPMT in the pancreas, and valuable for planning surgical strategy and successful operations for IPMT.
胰腺导管内乳头状黏液性肿瘤（IPMT）沿主胰管（MPD）或分支导管或两者蔓延。术中确定MPD中IPMT病变的范围对于成功实施手术很重要。
本研究纳入了27例连续接受手术的IPMT患者，这些患者均接受过内镜超声检查、内镜逆行胰胆管造影及计算机断层扫描作为诊断性检查。使用7.5兆赫环形阵列换能器和7.5兆赫传统换能器进行术中超声检查。所有患者均接受了手术，且病理诊断得以证实。将内镜超声检查、内镜逆行胰胆管造影、术中传统超声检查及术中环形阵列超声检查结果与切除标本的病理检查结果进行关联分析。确认了这4种检查方式在检测MPD和分支导管中IPMT病变方面的诊断准确性。
术中环形阵列超声检查诊断IPMT病变的标准是在MPD或分支导管或两者中存在边缘不规则的高回声肿块。27例患者中有22例在MPD中发现了IPMT病变。术中环形阵列超声检查检测出5例内镜超声检查或内镜逆行胰胆管造影未能发现的MPD中的IPMT病变。在这5例患者中的3例中，扩大了胰腺切除术范围以切除IPMT病变。术中环形阵列超声检查检测出3例术前检查未能发现的多灶性病变。对于MPD中IPMT病变的诊断，术中环形阵列超声检查的敏感性、特异性和总体准确性分别为86%、100%和89%；内镜逆行胰胆管造影的相应数值分别为50%、100%和59%；内镜超声检查的相应数值分别为59%、100%和67%；术中传统超声检查的相应数值分别为32%、100%和44%。对于分支导管中IPMT病变的诊断，术中环形阵列超声检查的敏感性、特异性和总体准确性分别为95%、100%和96%。
术中环形阵列超声检查适用于MPD的纵向扫描，有助于准确诊断胰腺中IPMT的范围，对于制定IPMT的手术策略及成功实施手术具有重要价值。
