Zacherl Johannes, Scheuba Christian, Imhof Martin, Zacherl Maximilian, Längle Friedrich, Pokieser Peter, Wrba Fritz, Wenzl Etienne, Mühlbacher Ferdinand, Jakesz Raimund, Steininger Rudolf
Department of Surgery, Division of General Surgery, AKH 21.A, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
World J Surg. 2002 May;26(5):550-4. doi: 10.1007/s00268-001-0266-2. Epub 2002 Feb 14.
Noninvasive liver imaging has developed rapidly resulting in increased accuracy for detecting primary and secondary hepatic tumors. Intraoperative ultrasonography (IOUS) was commonly considered to be the gold standard for liver staging, but the current value of IOUS is unknown in view of more sophisticated radiologic tools. The purpose of this prospective study was to evaluate the impact of IOUS on the treatment of 149 patients undergoing liver surgery for malignant disease (colorectal metastasis, 61 patients; hepatoma, 52 patients; other hepatic malignant tumors, 36 patients). The sensitivities of computed tomography (CT), helical CT, magnetic resonance imaging, and IOUS in patients with colorectal metastases were 69.2%, 82.5%, 84.9%, and 95.2% in a segment-by-segment analysis; in patients with hepatoma their sensitivities were 76.9%, 90.9%, 93.0%, and 99.3%; and in patients with other hepatic malignancies they were 66.7%, 89.6%, 93.3%, and 98.9%, respectively. Additional malignant lesions (AMLs) were first detected by inspection and palpation in 20 patients (13.4%). In another 18 patients (12.1%) IOUS revealed at least one AML. Overall, the findings obtained only by IOUS changed the surgical strategy in 34 cases (22.8%). It was concluded that IOUS, having undergone some refinement as well, still has immense diagnostic value in hepatectomy candidates. Frequently avoiding palliative liver resection and occasionally disproving unresectability as assessed by preoperative imaging, IOUS still has a significant impact on surgical decision making and should still be considered the gold standard.
无创肝脏成像技术发展迅速，提高了检测原发性和继发性肝肿瘤的准确性。术中超声检查（IOUS）曾被普遍认为是肝脏分期的金标准，但鉴于有了更先进的放射学工具，IOUS目前的价值尚不清楚。这项前瞻性研究的目的是评估IOUS对149例因恶性疾病接受肝脏手术患者（结直肠癌转移61例、肝癌52例、其他肝脏恶性肿瘤36例）治疗的影响。在逐段分析中，结直肠癌转移患者中计算机断层扫描（CT）、螺旋CT、磁共振成像和IOUS的敏感性分别为69.2%、82.5%、84.9%和95.2%；肝癌患者中其敏感性分别为76.9%、90.9%、93.0%和99.3%；其他肝脏恶性肿瘤患者中其敏感性分别为66.7%、89.6%、93.3%和98.9%。20例患者（13.4%）通过检查和触诊首次发现额外的恶性病变（AMLs）。另有18例患者（12.1%）IOUS发现至少一处AML。总体而言，仅通过IOUS获得的结果在34例（22.8%）中改变了手术策略。得出的结论是，经过改进的IOUS在肝切除候选患者中仍具有巨大的诊断价值。IOUS常常避免了姑息性肝切除，偶尔也推翻了术前影像学评估的不可切除性，它对手术决策仍有重大影响，仍应被视为金标准。
