Long Eliza E, Van Dam Jacques, Weinstein Stefanie, Jeffrey Brooke, Desser Terry, Norton Jeffrey A
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Surg Oncol. 2005 Aug;14(2):105-13. doi: 10.1016/j.suronc.2005.07.001.
Pancreas cancer is the fourth leading cancer killer in adults. Cure of pancreas cancer is dependent on the complete surgical removal of localized tumor. A complete surgical resection is dependent on accurate preoperative and intra-operative imaging of tumor and its relationship to vital structures. Imaging of pancreatic tumors preoperatively and intra-operatively is achieved by pancreatic protocol computed tomography (CT), endoscopic ultrasound (EUS), laparoscopic ultrasound (LUS), and intra-operative ultrasound (IOUS). Multi-detector CT with three-dimensional (3-D) reconstruction of images is the most useful preoperative modality to assess resectability. It has a sensitivity and specificity of 90 and 99%, respectively. It is not observer dependent. The images predict operative findings. EUS and LUS have sensitivities of 77 and 78%, respectively. They both have a very high specificity. Further, EUS has the ability to biopsy tumor and obtain a definitive tissue diagnosis. IOUS is a very sensitive (93%) method to assess tumor resectability during surgery. It adds little time and no morbidity to the operation. It greatly facilitates the intra-operative decision-making. In reality, each of these methods adds some information to help in determining the extent of tumor and the surgeon's ability to remove it. We rely on pancreatic protocol CT with 3-D reconstruction and either EUS or IOUS depending on the tumor location and operability of the tumor and patient. With these modern imaging modalities, it is now possible to avoid major operations that only determine an inoperable tumor. With proper preoperative selection, surgery is able to remove tumor in the majority of patients.
胰腺癌是成年人中第四大致命癌症。胰腺癌的治愈取决于对局部肿瘤进行完整的手术切除。完整的手术切除取决于术前和术中对肿瘤及其与重要结构关系的精确成像。术前和术中对胰腺肿瘤的成像可通过胰腺协议计算机断层扫描（CT）、内镜超声（EUS）、腹腔镜超声（LUS）和术中超声（IOUS）来实现。具有三维（3-D）图像重建功能的多排CT是评估可切除性最有用的术前检查方式。其敏感性和特异性分别为90%和99%。它不依赖于观察者。图像可预测手术结果。EUS和LUS的敏感性分别为77%和78%。它们都具有很高的特异性。此外，EUS能够对肿瘤进行活检并获得明确的组织诊断。IOUS是一种在手术期间评估肿瘤可切除性非常敏感（93%）的方法。它几乎不增加手术时间，也不会增加手术并发症。它极大地促进了术中决策。实际上，这些方法中的每一种都能提供一些信息，有助于确定肿瘤的范围以及外科医生切除肿瘤的能力。我们根据肿瘤的位置、肿瘤及患者的可手术性，依靠具有3-D重建功能的胰腺协议CT以及EUS或IOUS。借助这些现代成像方式，现在有可能避免仅确定肿瘤无法切除的大型手术。通过适当的术前选择，手术能够在大多数患者中切除肿瘤。
