Kaneko T, Nakao A, Nomoto S, Furukawa T, Hirooka Y, Nakashima N, Nagasaka T
Department of Surgery II, Faculty of Medicine, University of Nagoya, Japan.
Arch Surg. 1998 Mar;133(3):263-7. doi: 10.1001/archsurg.133.3.263.
To evaluate the diagnostic accuracy of intraoperative pancreatoscopy with the ultrathin pancreatoscope for the main pancreatic lesions of mucin-producing tumors of the pancreas (MPT).
Prospective diagnostic test study with a criterion standard of pathologic examination and masked comparison.
A university hospital.
Twenty-four consecutive patients with MPT referred for surgery in whom endoscopic retrograde pancreatography, endoscopic ultrasonography, and computed tomography had been performed as a diagnostic examination. All patients underwent surgery and the diagnosis was confirmed by pathologic examination.
Intraoperative pancreatoscopy was performed with the ultrathin pancreatoscope.
Findings of intraoperative pancreatoscopy, endoscopic retrograde pancreatography, and endoscopic ultrasonography were confirmed by pathologic examination of resected specimens. The diagnostic accuracy of these 3 modalities in detection of MPT lesions in the main pancreatic duct was compared.
The diagnostic criterion of MPT lesions in the main pancreatic duct by intraoperative pancreatoscopy was a granular and papillary mural nodule. An MPT lesion in the main pancreatic duct was found in 17 of 24 cases. Intraoperative pancreatoscopy detected 10 cases of intraductal MPT lesions that could not be detected by endoscopic ultrasonography or endoscopic retrograde pancreatography. Five of 10 cases were intraductal multicentric lesions. In 3 of these 5, additional pancreatic resection was performed. For diagnosis of MPT lesions, the sensitivity, specificity, and overall accuracy of intraoperative pancreatoscopy were all 100%; respective values were 43.8%, 100%, and 60.9% for endoscopic retrograde pancreatography and 47%, 100%, and 62.5% for endoscopic ultrasonography.
Intraoperative pancreatoscopy is safe and effective in diagnosing the intrapancreatic duct extension and multicentric lesions of MPT. It provides important information for operative strategy and contributes to successful pancreatic surgery.
评估术中使用超薄胰镜进行胰镜检查对胰腺黏液性肿瘤（MPT）主要胰腺病变的诊断准确性。
以前病理检查为标准对照的前瞻性诊断试验研究。
一家大学医院。
连续24例因MPT接受手术治疗的患者，术前均已行内镜逆行胰胆管造影（ERCP）、内镜超声检查（EUS）及计算机断层扫描（CT）作为诊断检查。所有患者均接受手术治疗，诊断经病理检查确诊。
术中使用超薄胰镜进行胰镜检查。
切除标本的病理检查证实术中胰镜检查、ERCP及EUS的检查结果。比较这三种检查方法对主胰管MPT病变的诊断准确性。
术中胰镜检查诊断主胰管MPT病变的标准为颗粒状及乳头状壁结节。24例患者中17例发现主胰管有MPT病变。术中胰镜检查发现10例ERCP及EUS未发现的导管内MPT病变。其中5例为导管内多中心病变，5例中的3例额外行了胰腺切除术。对于MPT病变的诊断，术中胰镜检查的敏感性、特异性及总体准确率均为100%；ERCP的相应值分别为43.8%、100%及60.9%，EUS的相应值分别为47%、100%及62.5%。
术中胰镜检查诊断MPT胰管内扩展及多中心病变安全有效。可为手术策略提供重要信息，有助于胰腺手术成功。
