Alberti Antonino, Dattola Pasquale, Littori Francesca, Dattola Arturo, Maccarone Pietro, Basile Maurizio
Istituto di Chirurgia Generale, 1a Clinica Chirurgica Generale e Terapia Chirurgica, Via Consolare Valeria, Gazzi, 98100 Messina.
Chir Ital. 2002 Jan-Feb;54(1):59-64.
Tumours of the head of the pancreas constitute the fourth most common cause of cancer deaths. These tumours are characterised by low survival rates (5% at 5 years) and low surgical resectability rates (20-25%). Liver metastases, lymph-node and vascular involvement, and peritoneal metastases are, in our opinion, exclusion criteria for curative surgical resection. The aim of the study was to evaluate the impact of intraoperative ultrasonography on the staging of such tumours. Over the period from 1990 to 2000 we introduced intraoperative ultrasonography in the staging of pancreatic cancer. We evaluated 51 patients who at preoperative staging had been regarded as candidates for surgical therapy consisting in a pancreaticoduodenectomy. All patients had been staged by preoperative abdominal ultrasound, ERCP, CT and MRI. Intraoperative ultrasound and colour-Doppler imaging (from 1997 on) revealed involvement of (i) the liver, (ii) the splenomesenteric vessels and (iii) the portal vein. Intraoperative ultrasonography yielded a diagnosis of occult liver metastases in 10 cases and signs of vascular involvement (absence of cleavage, partial and total thrombosis) in 12. One false-negative was registered. Intraoperative ultrasonography in our experience showed 98% sensitivity and specificity in the detection of vascular and lymph-node involvement. Its sensitivity in the detection of liver metastases was 100%. Intraoperative ultrasound is a procedure with a very high sensitivity in the operative staging of cancer of the head of the pancreas.
胰头肿瘤是癌症死亡的第四大常见原因。这些肿瘤的特点是生存率低（5年生存率为5%）和手术可切除率低（20%-25%）。在我们看来，肝转移、淋巴结和血管受累以及腹膜转移是根治性手术切除的排除标准。本研究的目的是评估术中超声检查对这类肿瘤分期的影响。在1990年至2000年期间，我们将术中超声检查引入胰腺癌分期。我们评估了51例患者，这些患者在术前分期时被视为适合进行胰十二指肠切除术的手术治疗候选人。所有患者均接受了术前腹部超声、内镜逆行胰胆管造影（ERCP）、计算机断层扫描（CT）和磁共振成像（MRI）检查。术中超声和彩色多普勒成像（从1997年起）显示（i）肝脏、（ii）脾肠系膜血管和（iii）门静脉受累。术中超声检查诊断出10例隐匿性肝转移和12例血管受累迹象（无间隙、部分和完全血栓形成）。记录到1例假阴性。根据我们的经验，术中超声检查在检测血管和淋巴结受累方面的敏感性和特异性为98%。其检测肝转移的敏感性为100%。术中超声检查在胰头癌手术分期中具有很高的敏感性。
