Gullà N, Patriti A, Cirocchi R, Fabbri B, Fabbri C, Tristaino B
Sezione di Chirurgia Generale e d'Urgenza, Dipartimento di Scienze Chirurgiche, Policlinico Monteluce, Università degli Studi, Perugia.
Minerva Chir. 2000 Nov;55(11):737-40.
The authors reviewed the experience on the use of laparoscopy performed since January 1997 in malignant neoplasms at their institution. The aim of the study was to evaluate the real effectiveness of this procedure in the staging of abdominal neoplasms which were considered resectable at preoperative examinations and in particular in the detection of peritoneal metastases not evidenced with traditional imaging techniques.
Twenty-eight patients with malignant neoplasms: colo-rectum (15), stomach (5), pancreas (4), gallbladder (2), cardias (1), liver (1), were studied. All the patients were preoperatively examined with abdominal computed tomography (CT). In the 2 patients with gallbladder neoplasm a MR cholangiography was also performed. An explorative laparoscopy with peritoneal washing was then performed in all the patients. The diagnostic and therapeutic choices were subsequently done on the basis of laparoscopy results.
Therapeutic approach was modified in 21% of cases, as a result of the detection of peritoneal metastases which were not evidenced with imaging examinations. On the contrary, peritoneal washing was not responsible of any preoperative evaluation.
Laparoscopy performed in patients with abdominal neoplasms allows the detection of peritoneal micrometastases not previously evidenced through preoperative CT, thus modifying the therapeutic approach.
作者回顾了自1997年1月以来在其机构中使用腹腔镜检查处理恶性肿瘤的经验。本研究的目的是评估该手术在术前检查时被认为可切除的腹部肿瘤分期中的实际有效性，特别是在检测传统成像技术未发现的腹膜转移方面的有效性。
对28例恶性肿瘤患者进行了研究，其中结直肠癌15例、胃癌5例、胰腺癌4例、胆囊癌2例、贲门癌1例、肝癌1例。所有患者术前均接受腹部计算机断层扫描（CT）检查。2例胆囊肿瘤患者还进行了磁共振胰胆管造影。然后对所有患者进行了带有腹膜冲洗的探查性腹腔镜检查。随后根据腹腔镜检查结果做出诊断和治疗选择。
由于检测到影像学检查未发现的腹膜转移，21%的病例治疗方案发生了改变。相反，腹膜冲洗对任何术前评估均无影响。
对腹部肿瘤患者进行腹腔镜检查可检测出术前CT未发现的腹膜微转移，从而改变治疗方案。
