Hoareau Julien, Venara Aurélien, Lebigot Jérôme, Hamel Jean-Francois, Lermite Emilie, Caroli-Bosc Francois Xavier, Aube Christophe
World J Surg. 2016 Jan;40(1):190-7. doi: 10.1007/s00268-015-3269-0.
The sensitivity of preoperative assessment of colorectal liver metastases (CRLM) ranges from 74 to 80%. Intraoperative ultrasound (IOUS) associated with contrast-enhanced intraoperative ultrasound (CE-IOUS) may be able to improve this. Thus, the aims of this study were to assess the value of IOUS and CE-IOUS for the surgical approach and to determine risk factors both for the detection of new nodules and for the modification of the surgical strategy.
Forty-three patients who underwent CRLM surgery were included. These patients had an MRI in the 8 weeks preceding surgery and benefited from intraoperative IOUS and CE-IOUS.
The use of IOUS/CE-IOUS permitted the identification of 43 additional lesions and an improved characterization of nodules in 23 patients with a resulting modification of surgical strategy. Lesions were down-staged in six patients and up-staged in six patients. Chemotherapy (p = 0.02) and the presence of nodules in the left lobe (p = 0.04) were predictive factors for finding new nodules at IOUS/CE-IOUS. The discovery of a new nodule systematically modified surgical management. IOUS/CE-IOUS improved intraoperative management of liver metastases. The techniques enable pertinent modification of surgical resections and a reduction of residual lesions.
结直肠癌肝转移（CRLM）术前评估的敏感性范围为74%至80%。术中超声（IOUS）联合造影增强术中超声（CE-IOUS）或许能够改善这一情况。因此，本研究的目的是评估IOUS和CE-IOUS在手术方案中的价值，并确定发现新结节以及改变手术策略的风险因素。
纳入43例行CRLM手术的患者。这些患者在手术前8周接受了MRI检查，并受益于术中IOUS和CE-IOUS。
使用IOUS/CE-IOUS可额外发现43个病灶，并改善了23例患者结节的特征，从而改变了手术策略。6例患者分期降低，6例患者分期升高。化疗（p = 0.02）和左叶存在结节（p = 0.04）是在IOUS/CE-IOUS时发现新结节的预测因素。新结节的发现会系统性地改变手术管理。IOUS/CE-IOUS改善了肝转移的术中管理。这些技术能够合理地改变手术切除方式并减少残留病灶。
