Nieveen van Dijkum E J, de Wit L T, van Delden O M, Rauws E A, van Lanschot J J, Obertop H, Gouma D J
Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
Cancer. 1997 Apr 1;79(7):1315-9.
The major advantage of diagnostic laparoscopy for patients with a gastrointestinal tumor is the prevention of unnecessary explorative laparotomies. However, it is doubtful whether this procedure also prevents late laparotomies that are necessary for palliative treatment during follow-up.
From January 1992 to July 1995, 233 consecutive patients with gastrointestinal malignancies underwent laparoscopy and laparoscopic ultrasonography after routine diagnostic procedures had shown potential curative disease.
After diagnostic laparoscopy, laparotomy was not performed in 21% of all patients (47 of 226) because of histologically proven, unresectable, mainly metastatic disease; 6% had esophageal tumors (4 of 64 patients), 43% had liver tumors (10 of 23), 43% had proximal bile duct tumors (9 of 21), 15% had periampullary tumors (17 of 111), and 43% had pancreatic body and tail tumors (3 of 7). Nonoperative palliation was successful in all patients. However, late laparotomies were necessary in 7 of these 47 patients (15%): 5 patients with periampullary tumors and 2 patients with proximal bile duct tumors. All 7 patients underwent a surgical bypass, most due to duodenal obstruction, 1 to 13 months after diagnostic laparoscopy.
In this study, diagnostic laparoscopy may have prevented unnecessary laparotomies for exploration or palliation in 18% of all patients (40 of 226). The procedure is of doubtful benefit for patients with esophageal tumors because the current findings show that only 6% of explorative laparotomies could be prevented. In patients with periampullary tumors, the initial benefit was 15%, but the risk of a late laparotomy is relatively high (30%).
诊断性腹腔镜检查对胃肠道肿瘤患者的主要优势在于可避免不必要的剖腹探查术。然而，该检查能否预防随访期间姑息治疗所需的晚期剖腹手术仍存疑问。
1992年1月至1995年7月，233例连续的胃肠道恶性肿瘤患者在常规诊断程序显示可能为可治愈疾病后接受了腹腔镜检查和腹腔镜超声检查。
诊断性腹腔镜检查后，21%（226例中的47例）的患者未进行剖腹手术，原因是经组织学证实为不可切除的主要转移性疾病；6%为食管肿瘤（64例患者中的4例），43%为肝肿瘤（23例中的10例），43%为近端胆管肿瘤（21例中的9例），15%为壶腹周围肿瘤（111例中的17例），43%为胰体尾肿瘤（7例中的3例）。所有患者非手术姑息治疗均成功。然而，这47例患者中有7例（15%）需要进行晚期剖腹手术：5例壶腹周围肿瘤患者和2例近端胆管肿瘤患者。所有7例患者均接受了手术旁路手术，大多数是由于十二指肠梗阻，在诊断性腹腔镜检查后1至13个月进行。
在本研究中，诊断性腹腔镜检查可能避免了18%（共226例中的40例）患者进行不必要的探查或姑息性剖腹手术。该检查对食管肿瘤患者的益处存疑，因为目前的研究结果显示仅能避免6%的探查性剖腹手术。对于壶腹周围肿瘤患者，初始获益为15%，但晚期剖腹手术的风险相对较高（30%）。
