Unità Operativa e Cattedra di Chirurgia Generale, Università degli Studi di Milano, Istituto Clinico Humanitas-IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy.
World J Surg. 2011 Nov;35(11):2521-7. doi: 10.1007/s00268-011-1199-z.
The introduction of contrast-enhanced ultrasound has been a major innovation in liver and pancreatic imaging. Previous studies have validated its intraoperative use during liver surgery, while there is a lack of data regarding its use during pancreatic surgery. The purpose of the present study was to prospectively evaluate the possible role of contrast-enhanced intraoperative ultrasound (CEIOUS) during resective pancreatic surgery for primary lesion characterization and intraoperative staging.
Thirty-four patients (70% males, mean age 67.9 years) were selected for pancreatic surgery between October 2006 and July 2009. All patients underwent intraoperative ultrasound with intravenous injection of 4.8 mL sulfur-hexafluoride microbubbles. Location of the primary tumor, relation to the main vessels, contrast medium uptake modalities, presence of liver metastases, and multifocal pancreatic involvement were evaluated. The majority of operations were pancreatoduodenectomies (70.6%) performed for pancreatic ductal adenocarcinoma (64.7%).
Additional lesions were detected by ultrasound in six patients (17.6%: liver metastases in four patients, a hemangioma in one patient, and a further pancreatic lesion in one patient). In five of these patients (5/34, 14.7%) surgical management was modified by these findings. All these new findings were diagnosed before injection of contrast medium, except for a metastasis from a neuroendocrine tumor; the characterization of the hemangioma was possible only after contrast injection. Intraoperative findings regarding location of primary tumor, relation to the main vessels, and lesion characterization did not differ from those obtained with preoperative imaging.
In our experience intraoperative ultrasound is a valid technique for intraoperative staging prior to pancreatic resection; it is unclear whether, in pancreatic surgery, the addition of contrast enhancement adds any benefit to traditional intraoperative ultrasound.
对比增强超声的引入是肝脏和胰腺成像领域的一项重大创新。先前的研究已经验证了其在肝外科手术中的术中应用，而关于其在胰腺手术中的应用则缺乏数据。本研究旨在前瞻性评估对比增强术中超声（CEIOUS）在原发性病变特征和术中分期的胰腺切除术中的可能作用。
2006 年 10 月至 2009 年 7 月期间，选择 34 例（70%为男性，平均年龄 67.9 岁）患者行胰腺手术。所有患者均接受静脉注射 4.8 毫升六氟化硫微泡的术中超声检查。评估原发性肿瘤的位置、与主要血管的关系、对比剂摄取方式、肝转移和多灶性胰腺受累情况。大多数手术为胰十二指肠切除术（70.6%），用于治疗胰腺导管腺癌（64.7%）。
6 例患者（17.6%：4 例患者存在肝转移，1 例患者存在肝血管瘤，1 例患者存在另一个胰腺病变）通过超声检测到其他病变。在这 5 例患者（5/34，14.7%）中，这些发现改变了手术管理。除神经内分泌肿瘤的转移灶外，所有这些新发现均在注射对比剂之前诊断，而血管瘤的特征仅在注射对比剂后才能确定。原发性肿瘤的位置、与主要血管的关系和病变特征的术中发现与术前影像学检查结果无差异。
根据我们的经验，术中超声是胰腺切除术前术中分期的有效技术；在胰腺手术中，对比增强的添加是否对传统术中超声有任何益处尚不清楚。
