Bemelman W A, de Wit L T, van Delden O M, Smits N J, Obertop H, Rauws E J, Gouma D J
Department of Surgery, University of Amsterdam, The Netherlands.
Br J Surg. 1995 Jun;82(6):820-4. doi: 10.1002/bjs.1800820633.
The aim of this study was to assess the additional role of diagnostic laparoscopy combined with laparoscopic ultrasonography in the staging of patients with pancreatic head malignancy. Between January 1993 and June 1994, 73 patients with stage I cancer of the pancreatic head determined by preoperative investigation (endoscopic retrograde cholangiopancreatography and Doppler ultrasonography) were eligible for laparoscopic ultrasonography. The peritoneal cavity was investigated for peritoneal deposits, intrahepatic metastases, malignant infiltration of the portal and superior mesenteric vessels, and N3 lymph node metastases. All patients without histologically proven metastases proceeded to laparotomy. Seventy patients were eligible for evaluation. Sixteen of the 21 patients with distant metastases were diagnosed by laparoscopy with ultrasonography. Forty-nine patients had surgical exploration and trial dissection to assess local resectability. Twenty-nine patients (41 per cent) had resectable pancreatic head tumours. The positive predictive value of local ingrowth as determined by laparoscopic sonography was 93 per cent. Laparotomy was avoided in 19 per cent of patients and the preoperative stage was changed in 41 per cent. Laparoscopy including ultrasonography was effective in staging pancreatic head malignancy.
本研究的目的是评估诊断性腹腔镜检查联合腹腔镜超声检查在胰头恶性肿瘤患者分期中的附加作用。1993年1月至1994年6月，73例经术前检查（内镜逆行胰胆管造影和多普勒超声检查）确定为I期胰头癌的患者符合腹腔镜超声检查条件。对腹腔进行检查，以寻找腹膜种植、肝内转移、门静脉和肠系膜上血管的恶性浸润以及N3淋巴结转移。所有未经组织学证实有转移的患者均进行剖腹手术。70例患者符合评估条件。21例远处转移患者中有16例通过腹腔镜超声检查确诊。49例患者进行了手术探查和试验性解剖以评估局部可切除性。29例患者（41%）有可切除的胰头肿瘤。腹腔镜超声检查确定局部侵犯的阳性预测值为93%。19%的患者避免了剖腹手术，41%的患者术前分期发生了改变。包括超声检查在内的腹腔镜检查在胰头恶性肿瘤分期中是有效的。
