Gouillat C, Ben-Hayoun E, Detry L, Bérard P
Département de Chirurgie, Hôtel Dieu, Lyon.
Ann Chir. 1991;45(7):534-9.
This retrospective study was designed to assess the specific contribution of intraoperative ultrasonography (IOU) in a series of 50 surgical procedures for malignant tumors of the liver (including 27 hepato-cellular carcinomas (HCC) secondary to cirrhosis and 18 metastases). Compared to conventional pre- and intra-operative investigations, IOU was more sensitive (81%) but less specific (27%) for detection of tumor nodules, but was inaccurate in detection of daughter nodules in hepato-cellular carcinomas (HCC) secondary to cirrhosis. The main specific contribution of IOU was assistance in performing surgery. In 14 cases (52%) of HCC secondary to cirrhosis, IOU provided one or several additional pieces of information which resulted in changes of the planned surgical procedure in 11 cases (41%) mainly enabling limited resection of small deep impalpable tumors. In 10 cases (37%), IOU directly guided resection (echo-guided segmentectomy or tumorectomy). Contribution of IOU was poor in primary carcinoma in non-cirrhotic liver, but in 8 cases of metastasis (44%) IOU provided additional information which resulted in changes of the intended surgical procedure in 5 cases (28%) mainly leading to a more extensive resection. Finally IOU was considered to be indispensable in 15 cases of HCC cirrhosis (56%) and in 5 cases of metastasis (28%).
本回顾性研究旨在评估术中超声检查（IOU）在50例肝脏恶性肿瘤手术（包括27例肝硬化继发肝细胞癌（HCC）和18例转移瘤）中的具体作用。与传统的术前和术中检查相比，IOU在检测肿瘤结节方面更敏感（81%）但特异性较低（27%），且在检测肝硬化继发肝细胞癌（HCC）的子结节方面不准确。IOU的主要具体作用是辅助手术。在14例（52%）肝硬化继发HCC病例中，IOU提供了一条或多条额外信息，其中11例（41%）导致计划手术方案改变，主要是能够对深部不可触及的小肿瘤进行有限切除。在10例（37%）病例中，IOU直接引导切除（超声引导下节段切除术或肿瘤切除术）。IOU在非肝硬化肝脏原发性癌中的作用较差，但在8例转移瘤（44%）中，IOU提供了额外信息，其中5例（28%）导致预期手术方案改变，主要是进行更广泛的切除。最后，15例HCC肝硬化（56%）和5例转移瘤（28%）病例中，IOU被认为是不可或缺的。
