Temudom T, Sarr M G, Douglas M G, Farnell M B
Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Pancreas. 1995 Oct;11(3):283-8. doi: 10.1097/00006676-199510000-00011.
Improve resolution of computed tomography (CT) and ultrasonography allows us to visualize the proximal extent of biliary obstruction and the presence of a periampullary mass in most patients with malignant extrahepatic biliary obstruction. Our purpose in this report is to challenge the need for preoperative percutaneous biopsy, endoscopic retrograde cholangiopancreatography, or preoperative placement of a biliary endoprosthesis in the good-risk patient in whom the imaging procedure clearly defines a periampullary mass and the proximal extent (hepatic extent) of biliary obstruction. We recently managed three patients in whom one of these invasive procedures led to a complication that delayed, prevented, or complicated appropriate operative resection of a pancreatic neoplasm. Because a negative percutaneous biopsy, cholangiographic imaging of a dilated bile/pancreatic duct clearly seen on CT or ultrasonography, or short-term preoperative biliary decompression does not alter the decision for operative exploration and may cause complications, we argue against their use in the good-risk patient with both extrahepatic biliary obstruction and a periampullary pancreatic mass well delineated on noninvasive imaging.
计算机断层扫描（CT）和超声检查分辨率的提高，使我们能够在大多数恶性肝外胆管梗阻患者中，可视化胆管梗阻的近端范围以及壶腹周围肿块的存在。在本报告中，我们的目的是对在影像检查明确界定壶腹周围肿块和胆管梗阻近端范围（肝内范围）的低风险患者中，术前进行经皮活检、内镜逆行胰胆管造影术或术前放置胆管内支架的必要性提出质疑。我们最近治疗了三名患者，其中这些侵入性操作之一导致了并发症，延迟、阻碍或使胰腺肿瘤的适当手术切除变得复杂。由于经皮活检结果为阴性、CT或超声检查中清晰可见的扩张胆管/胰管的胆管造影成像，或短期术前胆管减压并不能改变手术探查的决定，且可能导致并发症，因此我们反对在非侵入性影像检查中肝外胆管梗阻和壶腹周围胰腺肿块均清晰显示的低风险患者中使用这些检查。
