Court-Payen M, Skjoldbye B, Struckmann J, Nørgaard N, Pedersen I K, Bille-Brahe N E
Service d'Ultrasonographie, Hôpital de Herlev, Université de Copenhague, Danemark.
Ann Chir. 1997;51(4):318-25.
The aim of this prospective study was to study the impact of biopsies of liver metastases guided by laparoscopic ultrasound (LUS) and to evaluate various biopsy techniques.
Laparoscopy with LUS was performed on 18 consecutive patients with liver metastases considered to be surgically curable. Any new liver lesion which could lead to a therapeutic modification was biopsied, with a forceps or guided by LUS using four different techniques.
Of 17 patients successfully examined, a biopsy was indicated in 12 cases (71%), extension of the surgical procedure was decided in four cases (24%), and laparotomy was avoided in six cases (35%). The preoperative staging was correct in 15 stages (88%) and incorrect in two cases (12%). The positioning of the puncture needle in the axis of the scanning plane by "free hand" or in association with an abdominal transducer was effective, without complications.
Any liver lesion discovered by LUS which could lead to a modification or abstention of surgery should be biopsied, with LUS-guidance in the case of deep lesions. However, an optimal and universal guiding system for LUS-probes, has not yet been developed.
本前瞻性研究的目的是研究腹腔镜超声（LUS）引导下肝转移瘤活检的影响，并评估各种活检技术。
对18例连续的被认为可手术治愈的肝转移瘤患者进行了LUS腹腔镜检查。对任何可能导致治疗方案改变的新肝脏病变进行活检，使用活检钳或采用四种不同技术在LUS引导下进行活检。
在17例成功检查的患者中，12例（71%）进行了活检，4例（24%）决定扩大手术范围，6例（35%）避免了开腹手术。术前分期在15例（88%）中正确，2例（12%）中错误。通过“徒手”或与腹部探头联合将穿刺针置于扫描平面轴线上的定位方法有效，且无并发症。
LUS发现的任何可能导致手术改变或放弃手术的肝脏病变均应进行活检，对于深部病变应在LUS引导下进行。然而，尚未开发出一种适用于LUS探头的最佳通用引导系统。
