Meduri F, Diana F, Merenda R, Caldironi M W, Zuin A, Losacco L, Zani S, Gerunda G E, Maffei-Faccioli A
Department of Ist General Surgery, University of Padua, Italy.
Zentralbl Pathol. 1994 Aug;140(3):243-6.
Staging of pancreatic cancer still represents a challenge for surgeons involved in this field. Diagnostic methods of radiological imaging used routinely (CT, NMR, angiography) may understage this neoplasm. In fact, the presence of peritoneal or subglissonian hepatic micrometastases (< 2 cm) is a frequent surprise at laparotomy and forces the surgeon to use a palliative procedure. Actually this policy has not to be followed because the possibility to perform non-surgical palliation of jaundice or pain respectively by percutaneous radiological stent insertion and celiac alcoholization. In this viewpoint, preoperative staging has acquired an important role for a correct treatment, be it surgical or medical. Laparoscopy allows it to overcome the understaging produced by the more common diagnostic means, with the possibility to view directly the celomatic space and the surface of the abdominal viscera; moreover, during this procedure it is possible to perform a peritoneal washing to obtain other information about the cancer stage. In our experience, 56 patients were judged as resectable by radiologic methods; 31 were excluded from surgery by laparoscopy; 10 of the remaining 25 cases were submitted to radical resection. The operative resectability rate resulted in 40%, against 18% in cases where we submitted to surgery all the patients. Seven patients underwent peritoneal washing, always with a negative result; all were submitted to surgery and radically resected. In our opinion, laparoscopy and peritoneal washing represent useful tools in the staging of patients affected by pancreatic cancer.
胰腺癌的分期对于该领域的外科医生来说仍然是一项挑战。常规使用的放射影像学诊断方法（CT、核磁共振成像、血管造影）可能会低估这种肿瘤的分期。事实上，腹膜或肝门部肝微转移灶（<2厘米）的存在在剖腹手术时常常令人意外，迫使外科医生采用姑息性手术。实际上，由于分别通过经皮放射学支架置入和腹腔神经丛酒精注射进行黄疸或疼痛的非手术姑息治疗的可能性，不应遵循这种策略。从这个角度来看，术前分期对于正确的治疗（无论是手术治疗还是药物治疗）都具有重要作用。腹腔镜检查能够克服更常见诊断手段所导致的分期低估，有可能直接观察腹腔间隙和腹部脏器的表面；此外，在此过程中可以进行腹腔冲洗以获取有关癌症分期的其他信息。根据我们的经验，56例患者经放射学方法判断为可切除；31例经腹腔镜检查被排除在手术之外；其余25例中的10例接受了根治性切除。手术可切除率为40%，而在我们对所有患者都进行手术的情况下，这一比例为18%。7例患者进行了腹腔冲洗，结果均为阴性；所有这些患者都接受了手术并进行了根治性切除。我们认为，腹腔镜检查和腹腔冲洗是胰腺癌患者分期中的有用工具。
