Zhang Q, Nian W, Zhang L, Liang J
Department of Surgery, First Teaching Hospital, Beijing Medical University.
Chin Med J (Engl). 1996 Aug;109(8):622-5.
To evaluate preoperatively the extent of primary tumor, involvement of regional lymph node, and distant metastasis of ampullary carcinoma and extra hepatic bile duct carcinoma.
28 patients with ampullary carcinoma and the 18 patients with extrahepatic bile duct carcinoma were subjected to endoscopic ultrasonography (EUS). The results were compared with those of surgical explorations and pathological findings of the resected specimens for evaluating the accuracy of preoperative staging of EUS. 46 patients underwent surgical explorations. Radical resection with detailed pathological study was done for 22 patients with resectable ampullary carcinoma and 18 patients with extrahepatic bile duct carcinoma. Carcinomas of ampulla of Vater and extrahepatic bile duct were staged according to the tumor, nodes, metastasis (TNM) classification.
The accurate rate of EUS in assessing the extent of cancer invasion was 81.8% for ampullary carcinoma, and 72.2% for extrahepatic bile duct carcinoma. The accuracy of EUS in predicting regional lymph node metastasis was 59% for ampullary carcinoma, and 61.1% for extrahepatic bile duct carcinoma. Invasion of portal vein was correctly predicted by EUS in 2 of 3 patients, but the 3 cases of liver metastasis were not detected by EUS.
EUS is an effective method for the evaluation of the extent of invasion of ampullary carcinoma and extrahepatic bile duct carcinoma as well as the involvement of regional lymph node before operation. Because of its limited penetration depth, however, EUS is inadequate in the assessment of liver metastasis.
术前评估壶腹癌和肝外胆管癌的原发肿瘤范围、区域淋巴结受累情况及远处转移情况。
对28例壶腹癌患者和18例肝外胆管癌患者进行内镜超声检查（EUS）。将结果与手术探查结果及切除标本的病理检查结果进行比较，以评估EUS术前分期的准确性。46例患者接受了手术探查。对22例可切除的壶腹癌患者和18例肝外胆管癌患者进行了根治性切除并进行了详细的病理研究。根据肿瘤、淋巴结、转移（TNM）分类对 Vater 壶腹癌和肝外胆管癌进行分期。
EUS评估壶腹癌癌浸润范围的准确率为81.8%，评估肝外胆管癌的准确率为72.2%。EUS预测壶腹癌区域淋巴结转移的准确率为59%，预测肝外胆管癌的准确率为61.1%。EUS正确预测了3例门静脉侵犯患者中的2例，但未检测到3例肝转移病例。
EUS是术前评估壶腹癌和肝外胆管癌浸润范围及区域淋巴结受累情况的有效方法。然而，由于其穿透深度有限，EUS在评估肝转移方面存在不足。
