Katz Matthew H, Savides Thomas J, Moossa A R, Bouvet Michael
Department of Surgery, University of California, San Diego, 92161, USA.
Pancreatology. 2005;5(6):576-90. doi: 10.1159/000087500. Epub 2005 Aug 16.
Technology has revolutionized the diagnosis and staging of pancreatic malignancy. Previously, staging of disease was accomplished by exploratory laparotomy. Now, however, tumor size, lymph node and vascular involvement and the presence of metastases can be reliably assessed prior to operation using a widely available series of diagnostic tests, facilitating a preoperative assessment of tumor resectability. Appropriate use of these tests often spares patients with unresectable disease the need for operative intervention. As part of our staging algorithm we routinely employ a combination of clinical suspicion, a high-resolution helical CT scan and a serum CA 19-9 level. Endoscopic ultrasonography is useful in the patient in whom CT findings are equivocal, or in whom a tissue diagnosis is desired. Laparoscopy is reserved for patients with suspected advanced disease despite imaging findings to the contrary. Using this strategy, pancreatic malignancy may be diagnosed as expeditiously and as cost-effectively as is possible given current technology.
技术已经彻底改变了胰腺恶性肿瘤的诊断和分期。以前，疾病分期是通过剖腹探查术来完成的。然而现在，在手术前可以通过一系列广泛应用的诊断测试可靠地评估肿瘤大小、淋巴结及血管受累情况以及转移灶的存在，这有助于对肿瘤可切除性进行术前评估。合理使用这些测试通常可使患有不可切除疾病的患者无需进行手术干预。作为我们分期算法的一部分，我们常规采用临床怀疑、高分辨率螺旋CT扫描和血清CA 19-9水平相结合的方法。对于CT检查结果不明确或需要组织诊断的患者，内镜超声检查很有用。腹腔镜检查则保留用于那些尽管影像学检查结果相反但仍怀疑患有晚期疾病的患者。采用这种策略，在现有技术条件下，可以尽可能迅速且经济高效地诊断胰腺恶性肿瘤。
