Buice W S, Walker L G
Department of General Surgery, Charlotte Memorial Hospital, NC 28232.
Am Surg. 1989 May;55(5):307-10.
Controversy persists regarding the role of intraoperative biopsy in the treatment of resectable pancreatic and periampullary masses. The authors report their experience with intraoperative biopsy in 37 patients in whom preoperative diagnosis was unsuccessful. Tru-cut needle biopsy was positive in 86 per cent of patients with carcinoma of the pancreas, but was negative in all patients having periampullary neoplasms. Incisional biopsy was positive in 75 per cent of all patients, its accuracy being approximately equal in both groups of patients. Duodenotomy with open biopsy was performed in eight patients having periampullary lesions and was accurate in 88 per cent. Biopsy of lymph nodes not contraindicating resection was performed in 11 patients and was positive in only 18 per cent. Resections based on clinical findings suspicious of malignancy with either a negative biopsy or no biopsy attempted resulted in a 13 percent resection rate of patients having benign disease. These results indicate that while histologic determination of malignancy can be obtained in most resectable pancreatic and periampullary lesions, at least 12 per cent of such tumors remain undiagnosed by standard operative biopsy techniques. Pancreatoduodenectomy should proceed in these patients based on their clinical status and the surgeon's degree of experience with the procedure.
关于术中活检在可切除胰腺和壶腹周围肿块治疗中的作用，争议仍然存在。作者报告了他们对37例术前诊断未成功患者进行术中活检的经验。在胰腺癌患者中，粗针穿刺活检的阳性率为86%，但在所有壶腹周围肿瘤患者中均为阴性。切取活检在所有患者中的阳性率为75%，两组患者的准确性大致相同。对8例有壶腹周围病变的患者进行了十二指肠切开及开放活检，准确率为88%。对11例不适合切除的淋巴结进行活检，阳性率仅为18%。对于临床发现可疑恶性但活检阴性或未进行活检的患者进行切除，结果显示良性疾病患者的切除率为13%。这些结果表明，虽然大多数可切除的胰腺和壶腹周围病变能够通过组织学确定恶性程度，但至少12%的此类肿瘤通过标准手术活检技术仍无法确诊。对于这些患者，应根据其临床状况和外科医生对该手术的经验程度进行胰十二指肠切除术。
