Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK.
Am J Surg. 2012 Jul;204(1):84-92. doi: 10.1016/j.amjsurg.2011.07.018. Epub 2012 Jan 14.
The role of staging laparoscopy (SL) with laparoscopic ultrasound (LUS) in patients with resectable colorectal liver metastases (CRLM) remains controversial.
A meta-analysis of all studies (from 1998 to the present) on the effect of SL/LUS in patients with potentially resectable CRLM with respect to alteration in surgical management was performed.
Twelve studies satisfied the inclusion criteria. A total of 1,047 patients underwent SL/LUS. The true yield of SL/LUS for CRLM was 19% (95% confidence interval [CI], 16%-22%), with a diagnostic odds ratio of 132 (95% CI, 56-310) and an overall sensitivity of 59% (95% CI, 53%-65%). Subgroup analysis for detection of other liver and peritoneal lesions showed a sensitivity of 59% (95% CI, 49%-67%) and 75% (95% CI, 63%-85%) respectively. There was major between-study heterogeneity for all analyses, with no obvious cause revealed by meta-regression.
The true benefit of using SL/LUS universally seems limited. It appears more useful as an adjunct in patients when peritoneal disease is suspected.
在可切除结直肠肝转移（CRLM）患者中，分期腹腔镜检查（SL）联合腹腔镜超声（LUS）的作用仍存在争议。
对所有（1998 年至今）关于 SL/LUS 对潜在可切除 CRLM 患者手术管理改变效果的研究进行了荟萃分析。
12 项研究符合纳入标准，共 1047 例患者接受了 SL/LUS 检查。SL/LUS 对 CRLM 的真实检出率为 19%（95%置信区间，16%-22%），诊断比值比为 132（95%置信区间，56-310），总敏感度为 59%（95%置信区间，53%-65%）。对其他肝和腹膜病变的检测进行亚组分析，其敏感度分别为 59%（95%置信区间，49%-67%）和 75%（95%置信区间，63%-85%）。所有分析均存在明显的研究间异质性，但通过荟萃回归未发现明显原因。
普遍使用 SL/LUS 的真正益处似乎有限，在怀疑腹膜疾病时，SL/LUS 似乎更有助于辅助治疗。
