The Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, 1015 Walnut Street, 620 Curtis Building, Philadelphia, PA, 19107, USA.
J Gastrointest Surg. 2014 Jun;18(6):1100-7. doi: 10.1007/s11605-014-2501-9. Epub 2014 Mar 25.
Effective treatment of pancreatic pathology relies on both preoperative and intraoperative decision making. Traditionally, the use of preoperative imaging and endoscopic modalities, in combination with intraoperative findings and pathologic evaluation, has guided the surgeons to perform the correct operative procedure. We hypothesize that the intraoperative use of pancreatoscopy (fiberoptic endoscopy of the pancreatic duct) is a valuable adjunct in selected cases to facilitate the performance of the appropriate definitive surgical treatment. We queried our IRB-approved, prospectively maintained the pancreatic surgery database identifying the uses of intraoperative pancreatoscopy in all pancreatic resections at our institution from 2005-2012. Operative notes, pathology reports, and perioperative outcomes were evaluated. During the study period, 1,016 pancreatic resections were performed at our institution. Twenty-three cases during this period included the use of intraoperative pancreatoscopy. Eighteen (78 %) of these operations were performed for presumed main duct intraductal papillary mucinous neoplasm. In five cases (22 %), the surgical resection was extended secondary to the intraoperative pancreatoscopy findings. Appropriate surgical treatment of the pancreatic lesions can be challenging in the face of preoperative imaging limitations. The selective use of intraoperative fiberoptic endoscopy to evaluate the pancreatic duct appears to help to enable the surgeon to better perform the appropriate resection and optimal treatment.
有效的胰腺病理学治疗依赖于术前和术中的决策。传统上，术前影像学和内镜检查方法与术中发现和病理评估相结合，指导外科医生进行正确的手术程序。我们假设在某些情况下，术中使用胰管镜（胰腺管的纤维内镜检查）是一种有价值的辅助手段，有助于实施适当的确定性手术治疗。我们在经机构审查委员会批准的、前瞻性维护的胰腺外科数据库中进行了查询，确定了我们机构在 2005 年至 2012 年间所有胰腺切除术术中使用胰管镜的情况。评估了手术记录、病理报告和围手术期结果。在研究期间，我们机构进行了 1016 例胰腺切除术。在此期间的 23 例手术中包括术中使用胰管镜。这些手术中的 18 例（78%）是由于疑似主胰管内乳头状黏液性肿瘤而进行的。在 5 例（22%）中，由于术中胰管镜检查的结果，手术切除范围扩大。面对术前影像学的局限性，对胰腺病变进行适当的治疗具有挑战性。选择性地使用术中纤维内镜检查来评估胰管似乎有助于外科医生更好地进行适当的切除和最佳治疗。
