Anderson D N, Campbell S, Park K G
Department of Surgery, Aberdeen Royal Infirmary, Foresterhill, UK.
Br J Surg. 1996 Oct;83(10):1424-8. doi: 10.1002/bjs.1800831033.
Laparoscopic ultrasonographic staging was compared prospectively with conventional computed tomography (CT) and ultrasonographic staging of 24 lower-third oesophageal tumors and 20 gastric malignancies. Following laparoscopic ultrasonography, seven patients regarded as being resectable after conventional imaging were excluded from surgical exploration because of ascites with peritoneal deposits (four patients), liver metastases (one), advanced local disease (one) and poor tolerance of general anaesthesia (one). Preoperative T and N stages were compared with the pathological staging following resection in 34 patients. Laparoscopic ultrasonography was significantly more accurate than conventional CT and ultrasonography in assessment of the primary tumour (91 versus 64 per cent, P < 0.01) and nodal status (91 versus 62 per cent, P < 0.05). The addition of laparoscopic ultrasonography to conventional procedures for staging upper gastrointestinal malignancy improved the overall accuracy of staging. Although this may have future implications for the selection of patients for multimodality treatment, management decisions are currently based on laparoscopic findings, which in this study resulted in a resection rate of 97 per cent.
对24例食管下段肿瘤和20例胃恶性肿瘤患者，前瞻性地比较了腹腔镜超声分期与传统计算机断层扫描（CT）及超声分期。在腹腔镜超声检查后，7例在传统影像学检查后被认为可切除的患者，因出现腹水伴腹膜种植转移（4例）、肝转移（1例）、局部病变进展（1例）和全身麻醉耐受性差（1例）而被排除在手术探查之外。对34例患者术前的T和N分期与切除术后的病理分期进行了比较。在评估原发肿瘤方面，腹腔镜超声检查比传统CT和超声检查显著更准确（91%对64%，P<0.01），在评估淋巴结状态方面也是如此（91%对62%，P<0.05）。将腹腔镜超声检查添加到传统的上消化道恶性肿瘤分期程序中，提高了分期的总体准确性。尽管这可能对选择接受多模式治疗的患者有未来意义，但目前的管理决策基于腹腔镜检查结果，在本研究中这导致了97%的切除率。
