Melzer E, Avidan B, Heyman Z, Coret A, Bar-Meir S
Department of Gastroenterology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Isr J Med Sci. 1996 Nov;32(11):1086-8.
The major prerequisite for resection of a pancreatic tumor is non-involvement of large blood vessels. Preoperative assessment of blood vessel infiltration may prevent unnecessary surgery. The aim of our study was to investigate the accuracy of endoscopic ultrasonography (EUS) in diagnosis of pancreatic cancer and in preoperative staging. Thirteen patients (7 females, 6 males; mean age 64 years) with a pancreatic tumor, but no evidence of distant metastases, underwent EUS and computerized tomography (CT) in order to assess blood vessel involvement by the tumor. The results were compared with intraoperative findings in 12 patients and with postmortem findings in 1 patient. A tumor was demonstrated by EUS in 12 patients and was confirmed at surgery in all 12 patients. In one patient no tumor was demonstrated by EUS, although a tumor was visible by CT; no tumor was found at surgery. In two patients CT failed to demonstrate a pancreatic tumor that was demonstrated by EUS; at surgery a tumor was detected in both patients. EUS detected blood vessel involvement in seven patients, which was confirmed at surgery in six of them. In the other six patients surgery confirmed the EUS finding of no blood vessel involvement. CT detected blood vessel involvement in two patients only. The overall accuracy of EUS and CT for detecting the tumor was 100% and 77% respectively, and for blood vessel involvement 92% and 61% respectively. In conclusion, EUS is an accurate procedure for preoperative assessment of blood vessel involvement in patients with pancreatic cancer. This procedure may enable the selection of those patients who may benefit from surgery, and should be part of the evaluation of patients with pancreatic cancer who are candidates for curative surgery.
胰腺肿瘤切除的主要前提是大血管未受侵犯。术前评估血管浸润情况可避免不必要的手术。我们研究的目的是探讨内镜超声检查（EUS）在胰腺癌诊断及术前分期中的准确性。13例胰腺肿瘤患者（7例女性，6例男性；平均年龄64岁），无远处转移证据，接受了EUS和计算机断层扫描（CT）以评估肿瘤对血管的侵犯情况。将结果与12例患者的术中所见及1例患者的尸检结果进行比较。EUS在12例患者中发现了肿瘤，所有12例均在手术中得到证实。1例患者EUS未发现肿瘤，尽管CT可见肿瘤；手术中未发现肿瘤。2例患者CT未显示出EUS所发现的胰腺肿瘤；手术中在这2例患者中均检测到肿瘤。EUS检测到7例患者有血管侵犯，其中6例在手术中得到证实。另外6例患者手术证实了EUS未发现血管侵犯的结果。CT仅在2例患者中检测到血管侵犯。EUS和CT检测肿瘤的总体准确率分别为100%和77%，检测血管侵犯的准确率分别为92%和61%。总之，EUS是一种准确的术前评估胰腺癌患者血管侵犯情况的方法。该方法可有助于筛选可能从手术中获益的患者，应成为对适合根治性手术的胰腺癌患者进行评估的一部分。
