Callery M P, Strasberg S M, Doherty G M, Soper N J, Norton J A
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
J Am Coll Surg. 1997 Jul;185(1):33-9.
Open laparotomy has traditionally been required to stage hepatobiliary and pancreatic (HBP) cancers accurately. For unresectable patients, costs and morbidity have been high. Today, laparoscopy alone or combined with laparoscopic ultrasonography (LUS) is being examined for its value in defining the extent of malignancy.
We have analyzed the effect of routine implementation of this new staging technique in our HBP center. Staging laparoscopy (SL) with LUS was performed in 50 consecutive patients with HBP malignancies. All patients were considered to have resectable tumors as determined by traditional preoperative staging modalities. Primary tumors were located in the liver (n = 7), biliary tract (n = 11), or pancreas (n = 32). An average of 2.7 preoperative studies per patient were performed prior to SL-LUS.
Staging laparoscopy with laparoscopic ultrasonography predicted resectable tumors in 28 patients (56%). At laparotomy, 26 of 28 were actually resectable: the false-negative rate was 4%. Staging laparoscopy with laparoscopic ultrasonography indicated unresectability in 22 patients (44%). Staging laparoscopy alone demonstrated previously unrecognized occult metastases in 11 patients (22%). In 11 other patients (22%) in whom SL alone was negative, LUS established unresectability from vascular invasion (n = 5), lymph node metastases (n = 5), or intraparenchymal hepatic tumor (n = 1). All cases of unresectability due to vascular invasion were validated by laparotomy. Five of six lymph node or hepatic metastases were proved histologically by LUS-guided needle biopsy rather than laparotomy.
Unnecessary laparotomy can be safely avoided by SL-LUS in many patients with HPB malignancies, reducing costs and morbidity.
传统上，需要进行开放性剖腹手术才能准确分期肝胆胰（HBP）癌。对于无法切除的患者，成本和发病率一直很高。如今，单独的腹腔镜检查或与腹腔镜超声检查（LUS）联合使用正在接受评估，以确定其在确定恶性肿瘤范围方面的价值。
我们分析了在我们的HBP中心常规实施这种新分期技术的效果。对50例连续的HBP恶性肿瘤患者进行了带有LUS的分期腹腔镜检查（SL）。根据传统的术前分期方式，所有患者均被认为有可切除的肿瘤。原发性肿瘤位于肝脏（n = 7）、胆道（n = 11）或胰腺（n = 32）。在进行SL-LUS之前，每位患者平均进行了2.7项术前检查。
带有腹腔镜超声检查的分期腹腔镜检查预测28例患者（56%）的肿瘤可切除。在剖腹手术中，28例中有26例实际上可切除：假阴性率为4%。带有腹腔镜超声检查的分期腹腔镜检查表明22例患者（44%）无法切除。单独的分期腹腔镜检查在11例患者（22%）中发现了先前未被识别的隐匿性转移。在另外11例（22%）单独SL为阴性的患者中，LUS因血管侵犯（n = 5）、淋巴结转移（n = 5）或肝实质内肝肿瘤（n = 1）确定无法切除。所有因血管侵犯导致无法切除的病例均通过剖腹手术得到证实。六例淋巴结或肝转移中有五例通过LUS引导的针吸活检而非剖腹手术得到组织学证实。
对于许多HBP恶性肿瘤患者，SL-LUS可以安全地避免不必要的剖腹手术，降低成本和发病率。
