Minnard E A, Conlon K C, Hoos A, Dougherty E C, Hann L E, Brennan M F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York City, New York 10021, USA.
Ann Surg. 1998 Aug;228(2):182-7. doi: 10.1097/00000658-199808000-00006.
To define the role of laparoscopic ultrasound (LUS) in the staging of pancreatic tumors.
Laparoscopy has recently been established as a valuable tool in the staging of pancreatic cancer. It has been suggested that the addition of LUS to standard laparoscopy could improve the accuracy of this procedure.
A prospective evaluation of 90 patients with pancreatic tumors undergoing laparoscopy and LUS was performed over a 27-month period. LUS equipped with an articulated curved and linear array transducer (6 to 10 MHz) was used. All patients underwent rigorous laparoscopic examination. Clinical, surgical, and pathologic data were collected.
The median age was 65 years (range 43 to 85 years). Sixty-four patients had tumors in the head, 19 in the body, and 3 in the tail of the pancreas. Four patients had ampullary tumors. LUS was able to image the primary tumor (98%), portal vein (97%), superior mesenteric vein (94%), hepatic artery (93%), and superior mesenteric artery (93%) in these patients. LUS was particularly helpful in determining venous involvement (42%) and arterial involvement (38%) by the tumor. This resulted in a change in surgical treatment for 13 (14%) of the 90 patients in whom standard laparoscopic examination was equivocal.
LUS is useful in evaluating the primary tumor and peripancreatic vascular anatomy. When standard laparoscopic findings are equivocal, LUS allowed accurate determination of resectability. Supplementing laparoscopy with LUS offers improved assessment and preoperative staging of pancreatic cancer.
明确腹腔镜超声（LUS）在胰腺肿瘤分期中的作用。
腹腔镜检查最近已成为胰腺癌分期的一项重要工具。有人提出，在标准腹腔镜检查中增加LUS可提高该检查的准确性。
在27个月的时间里，对90例接受腹腔镜检查和LUS的胰腺肿瘤患者进行了前瞻性评估。使用配备有关节弯曲和线性阵列换能器（6至10MHz）的LUS。所有患者均接受了严格的腹腔镜检查。收集了临床、手术和病理数据。
中位年龄为65岁（范围43至85岁）。64例患者的肿瘤位于胰头，19例位于胰体，3例位于胰尾。4例患者有壶腹肿瘤。LUS能够对这些患者的原发肿瘤（98%）、门静脉（97%）、肠系膜上静脉（94%）、肝动脉（93%）和肠系膜上动脉（93%）进行成像。LUS在确定肿瘤的静脉受累（42%）和动脉受累（38%）方面特别有帮助。这导致90例标准腹腔镜检查结果不明确的患者中有13例（14%）的手术治疗方案发生了改变。
LUS有助于评估原发肿瘤和胰腺周围血管解剖结构。当标准腹腔镜检查结果不明确时，LUS能够准确确定肿瘤的可切除性。用LUS补充腹腔镜检查可改善对胰腺癌的评估和术前分期。
