术中胰腺镜检查可提高胰管内乳头状黏液性肿瘤手术中隐匿性病变的检出率：一项初步研究。

Intraoperative pancreatoscopy can improve the detection of skip lesions during surgery for intraductal papillary mucinous neoplasia: A pilot study.

机构信息

Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden; Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.

出版信息

Pancreatology. 2023 Sep;23(6):704-711. doi: 10.1016/j.pan.2023.06.006. Epub 2023 Jun 12.

DOI:10.1016/j.pan.2023.06.006

PMID:37336668

Abstract

OBJECTIVES

Intraoperative pancreatoscopy is a promising procedure that might guide surgical resection for suspected main duct (MD) and mixed type (MT) intraductal papillary mucinous neoplasms (IPMNs). The aim of the present study was to assess the diagnostic yield and clinical impact of intraoperative pancreatoscopy in patients operated on for MD and MT-IPMNs.

METHODS

This is a retrospective cohort study. Patients undergoing surgery for suspected MD or MT-IPMN underwent intraoperative pancreatoscopy and frozen section analysis. In all patients who required extended resection due to pancreatoscopic findings, we compared the final histology with the results of the intraoperative frozen section analysis.

RESULTS

In total, 46 patients, 48% females, mean age (range) 67 years (45-82 years) underwent intraoperative pancreatoscopy. No mortality or procedure related complications were observed. Pancreatoscopy changed the operative course in 30 patients (65%), leading to extended resections in 20 patients (43%) and to parenchyma sparing procedures in 10 patients (22%). Analyzing the group of patients who underwent extended resections, 7 (35%) displayed lesions that needed further surgical treatment (six high grade dysplasia and one with G1 pancreatic neuroendocrine tumor) and among those 7, just 1 (14%) would have been detected exclusively with histological frozen section analysis of the transection margin. The combination of both pancreatoscopy and frozen section analysis lead to 86% sensitivity and 92% specificity for the detection of pathological tissue in the remnant pancreas.

CONCLUSION

Intraoperative pancreatoscopy is a safe and feasible procedure and might allow the detection of skip lesions during surgery for suspect MD-involving IPMNs.

摘要

目的

术中胰管镜检查是一种有前途的方法，可能有助于指导怀疑主胰管（MD）和混合型（MT）胰管内乳头状黏液性肿瘤（IPMNs）的手术切除。本研究旨在评估术中胰管镜检查对接受 MD 和 MT-IPMN 手术患者的诊断效果和临床影响。

方法

这是一项回顾性队列研究。对接受疑似 MD 或 MT-IPMN 手术的患者进行术中胰管镜检查和冷冻切片分析。对于所有因胰管镜检查结果需要扩大切除的患者，我们将最终组织学与术中冷冻切片分析结果进行比较。

结果

共有 46 名患者（48%为女性）接受了术中胰管镜检查，平均年龄（范围）为 67 岁（45-82 岁）。无死亡或与手术相关的并发症发生。胰管镜检查改变了 30 名患者（65%）的手术过程，导致 20 名患者（43%）进行了扩大切除术，10 名患者（22%）进行了保留实质的手术。在接受扩大切除术的患者组中，有 7 名（35%）显示需要进一步手术治疗的病变（6 名高级别异型增生和 1 名 G1 胰腺神经内分泌肿瘤），而在这 7 名患者中，只有 1 名（14%）仅通过肝门部断面的组织学冷冻切片分析就能被检测到。胰管镜检查和冷冻切片分析的联合应用可使残留胰腺中病理性组织的检出率达到 86%的敏感性和 92%的特异性。