Takeuchi N, Ramirez J M, Mortensen N J, Cobb R, Whittlestone T
Department of Colorectal Surgery, John Radcliffe Hospital, Headington, Oxford, UK.
Int J Colorectal Dis. 1996;11(2):92-5. doi: 10.1007/BF00342467.
Approximately 20-25% of colorectal cancers have hepatic metastases at the time of operation and occult liver secondaries appear in 10-30% of curatively operated cases. Intraoperative liver ultrasonography has been reported to be the most accurate method for detecting colorectal metastases. A consecutive series of 119 colorectal cancer patients was studied by routine extracorporeal preoperative ultrasound (EUS), inspection and palpation of the liver at laparotomy and intraoperative liver ultrasound (IUS). 19 patients had liver metastases at the time of surgery. In eight, diagnosis was by EUS. Inspection and palpation yielded a further seven, and IUS alone a further four. Additional lesions were detected in 3 patients after preoperative ultrasound and in 6 patients following intraoperative palpation of the liver. In a further 4 cases IUS demonstrated additional metastases. Follow up for a median 38 months (12-59) was by clinical examination and six monthly liver ultrasound. During this time 8 patients, who were thought to have a clear liver, developed hepatic metastases. The mean time from surgery to the detection of occult hepatic metastases was 14.7 (8-26) months and 4 of these appeared in the second year. Intraoperative ultrasonography is a sensitive and useful method in detecting liver metastases, and may improve clinical staging and the selection of patients for further therapy. However some occult hepatic metastases will remain undetected.
约20%-25%的结直肠癌患者在手术时已有肝转移，10%-30%接受根治性手术的患者会出现隐匿性肝转移。据报道，术中肝脏超声检查是检测结直肠癌肝转移最准确的方法。我们对119例结直肠癌患者进行了连续研究，采用常规体外术前超声（EUS）、剖腹手术时肝脏检查及触诊以及术中肝脏超声（IUS）。19例患者在手术时有肝转移。其中8例通过EUS诊断，检查及触诊又发现7例，仅通过IUS发现4例。术前超声检查后，3例患者发现了额外的病灶，术中肝脏触诊后又发现6例。另有4例通过IUS发现了额外的转移灶。随访时间中位数为38个月（12-59个月），采用临床检查及每6个月一次的肝脏超声检查。在此期间，8例原本被认为肝脏无转移的患者出现了肝转移。从手术到发现隐匿性肝转移的平均时间为14.7个月（8-26个月），其中4例在第二年出现。术中超声检查是检测肝转移的一种敏感且有用的方法，可能会改善临床分期并有助于选择进一步治疗的患者。然而，一些隐匿性肝转移仍可能未被发现。
