Snady H, Bruckner H, Siegel J, Cooperman A, Neff R, Kiefer L
Division of Gastroenterology, Mt. Sinai Medical Center (CUNY), New York.
Gastrointest Endosc. 1994 May-Jun;40(3):326-33. doi: 10.1016/s0016-5107(94)70065-6.
Endoscopic ultrasonography was used to examine 38 patients with a pancreatic neoplasm (mean size, 2.8 cm; range, 1 to 5 cm). Three EUS signs appear to be reliable criteria for the identification of tumor invasion of major veins forming the portal confluence: (1) peri-pancreatic venous collaterals in the area of a mass that obliterates the normal anatomic location of a major portal confluence vessel; (2) tumor within the vessel lumen; and (3) abnormal vessel contour with loss of the vessel-parenchymal sonographic interface. At least one of these signs was present in each of the 21 patients with vascular invasion; none of them was present in the 17 patients without vascular invasion. Findings were confirmed by laparotomy plus biopsy (33 patients), autopsy (1 patient), or angiography plus biopsy (4 patients). Arterial involvement was identified by alteration of vessel course and caliber. All 7 patients with arterial involvement also had venous involvement. These signs provide reliable criteria for endoscopic ultrasonographic definition of unresectable tumors in patients with a pancreatic neoplasm that appears to be resectable on standard radiologic tests.
采用内镜超声检查38例胰腺肿瘤患者（平均大小2.8 cm；范围1至5 cm）。三种内镜超声征象似乎是识别形成门静脉汇合处的主要静脉受肿瘤侵犯的可靠标准：（1）肿块区域内胰腺周围静脉侧支循环，其使主要门静脉汇合血管的正常解剖位置消失；（2）血管腔内有肿瘤；（3）血管轮廓异常，血管-实质超声界面消失。21例有血管侵犯的患者中每例至少有上述一种征象；17例无血管侵犯的患者均无这些征象。通过剖腹手术加活检（33例患者）、尸检（1例患者）或血管造影加活检（4例患者）证实了检查结果。通过血管走行和管径改变识别动脉受累情况。所有7例有动脉受累的患者也有静脉受累。这些征象为内镜超声界定胰腺肿瘤患者中标准放射学检查看似可切除但实际不可切除的肿瘤提供了可靠标准。
