Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1- Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
World J Surg. 2011 Dec;35(12):2779-87. doi: 10.1007/s00268-011-1264-7.
Intraoperative detection of new nodules is common in patients undergoing hepatectomy for colorectal liver metastases, although the value of intraoperative diagnosis is not well assessed.
A prospectively collected and recorded database was retrospectively analyzed. Helical computed tomography (CT) results were correlated with those of the intraoperative diagnosis in 183 consecutive patients undergoing 254 consecutive hepatectomies, including repeated resection for colorectal liver metastases.
In total, 270 nodules were newly detected during 65 hepatectomies. The sensitivity of CT to detect metastatic nodules was 72.8% (722/992), but it decreased to 34.6% (125/361) for small (≤ 1 cm diameter) tumors. Intraoperative visual inspection and/or palpation detected 207 of 270 nodules. Intraoperative ultrasonography (IOUS) played an important role in identifying deep (≥ 1 cm from the surface) and comparatively small (≤ 1 cm diameter) nodules (4/9 vs. 16/18, respectively, for those >1 cm vs. ≤ 1 cm diameter). The likelihood of intraoperative detection of new nodules increased from 10 in 112 to 6 in 9 when the preoperative tumor number increased from solitary to ≥ 10, resulting in an overall likelihood of 65 in 254 (25.6%). Of 65 patients with new nodules, 21 had at least one nodule that was detected only by IOUS. Preoperatively scheduled hepatectomy was altered in 47 (72%) patients, although additional limited resection(s) were sufficient to remove these nodules in 43 (91%) of them.
Visual inspection, palpation, and IOUS had equally indispensable roles in detecting new nodules during hepatectomy. Detection was common and usually necessitated alteration, albeit moderately, of the surgical plan.
在因结直肠肝转移行肝切除术的患者中，术中发现新结节较为常见，尽管术中诊断的价值尚未得到充分评估。
对前瞻性收集和记录的数据库进行回顾性分析。对 183 例连续患者的 254 例连续肝切除术（包括结直肠肝转移的再次切除）中，螺旋 CT 结果与术中诊断结果进行了相关性分析。
共有 65 次肝切除术中发现 270 个新结节。CT 检测转移性结节的敏感性为 72.8%（722/992），但对于直径≤1cm 的小结节敏感性降至 34.6%（125/361）。术中肉眼观察和/或触诊发现了 270 个结节中的 207 个。术中超声（IOUS）在识别深部（距表面≥1cm）和较小（直径≤1cm）结节方面发挥了重要作用（分别为 4/9 和 16/18，对于直径>1cm 和≤1cm 的结节）。术前肿瘤数量从 1 个增加到≥10 个时，新结节术中检出的可能性从 10 个增加到 6 个，254 例中总体检出率为 65 例（25.6%）。在 65 例有新结节的患者中，21 例至少有 1 个结节仅通过 IOUS 检测到。47 例（72%）患者改变了术前计划行肝切除术，尽管其中 43 例（91%）通过额外的有限切除术足以切除这些结节。
术中肉眼观察、触诊和 IOUS 在检测肝切除术中的新结节方面具有同等不可或缺的作用。术中发现新结节较为常见，通常需要适度改变手术计划。
