Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA.
Gastrointest Endosc. 2010 Nov;72(5):1089-94. doi: 10.1016/j.gie.2010.07.023.
Precise localization of small pancreatic tumors during laparoscopic distal pancreatectomy (LDP) can be difficult because of decreased tactile ability of laparoscopy and the homogeneous appearance of the pancreas and surrounding retroperitoneal fat. Precise localization of the lesion is critical to achieving adequate margins of resection and preserving healthy pancreatic tissue. EUS-guided fine-needle tattooing (EUS-FNT) of a pancreatic lesion before LDP has been described in single case reports, but no large series have reported its effectiveness in patients undergoing LDP.
To assess the feasibility, safety, and efficacy of EUS-FNT in consecutive patients undergoing LDP.
Retrospective cohort study.
Tertiary-care referral hospital.
This study involved 30 consecutive patients who underwent LDP from 2008 to 2010. Thirteen had EUS-FNT followed by LDP, and 17 had LDP alone.
LDP or EUS-FNT with a sterile carbon-particle tattoo followed by LDP.
The following features were examined: the technical success and complication rates of EUS-FNT, visibility of the tattoo at the time of laparoscopy, durability of the tattoo, and pathologic absence of tumor at the resection margin.
The final pathology of pancreatic lesions of patients who had EUS-FNT was similar to those who had LDP alone. The median resected tumor size was significantly larger for the LDP-alone patients (median 4.0 cm vs 1.3 cm; P = .03). Thirty-one percent (4/13) of lesions in the EUS-FNT group were not visualized by prior preoperative pancreatic protocol CT. EUS-FNT was feasible in all 13 patients at laparoscopy, with R0 resection and negative final pathology margins in all cases. The tattoo was visible in all 13 EUS-FNT cases, with mean time from EUS-FNT to surgery of 20.3 days (range, 3-69 days). There were no significant complications associated with EUS-FNT.
Small, retrospective, single-center study.
Preoperative EUS-FNT of lesions was technically feasible and safe, and it assisted in the localization of lesions in patients before LDP. The carbon particle tattoo was durable and visible in all cases.
腹腔镜下胰体尾切除术（LDP）时，由于腹腔镜下触觉能力下降以及胰腺和周围腹膜后脂肪的均匀外观，难以精确定位小胰腺肿瘤。准确定位病变对于实现足够的切除边缘和保留健康的胰腺组织至关重要。在 LDP 之前，EUS 引导下的细针纹身（EUS-FNT）已在单病例报告中描述，但尚无大系列报告其在接受 LDP 的患者中的有效性。
评估 EUS-FNT 在连续接受 LDP 的患者中的可行性、安全性和有效性。
回顾性队列研究。
三级转诊医院。
这项研究涉及 2008 年至 2010 年间接受 LDP 的 30 名连续患者。其中 13 例接受了 EUS-FNT 联合 LDP，17 例仅接受了 LDP。
LDP 或 EUS-FNT 联合无菌碳粒纹身，然后行 LDP。
EUS-FNT 的技术成功率和并发症发生率、腹腔镜时纹身的可见性、纹身的耐久性以及切除边缘无肿瘤的病理情况。
接受 EUS-FNT 的患者的胰腺病变的最终病理与仅接受 LDP 的患者相似。仅接受 LDP 的患者切除的肿瘤中位数明显较大（中位数 4.0 cm 比 1.3 cm；P =.03）。EUS-FNT 组的 31%（4/13）病变在术前胰腺方案 CT 中无法看到。EUS-FNT 在所有 13 例腹腔镜下均可行，所有病例均行 R0 切除，最终病理切缘均为阴性。在所有 13 例 EUS-FNT 病例中均可见纹身，EUS-FNT 与手术之间的平均时间为 20.3 天（范围，3-69 天）。EUS-FNT 无明显并发症。
小、回顾性、单中心研究。
术前 EUS-FNT 定位病变在技术上是可行和安全的，并有助于在 LDP 前定位病变。碳粒纹身持久且在所有病例中均可见。
