Goletti O, Celona G, Galatioto C, Viaggi B, Lippolis P V, Pieri L, Cavina E
Department of Surgery, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
Surg Endosc. 1998 Oct;12(10):1236-41. doi: 10.1007/s004649900827.
Laparoscopic colectomy has developed rapidly with the explosion of technology. In most cases, laparoscopic resection is performed for colorectal cancer. Intraoperative staging during laparoscopic procedure is limited. Laparoscopic ultrasonography (LUS) represents the only real alternative to manual palpation during laparoscopic surgery.
We evaluated the diagnostic accuracy of LUS in comparison with preoperative staging and laparoscopy in 33 patients with colorectal cancer. Preoperative staging included abdominal US, CT, and endoscopic US (for rectal cancer). Laparoscopy and LUS were performed in all cases. Pre- and intraoperative staging were related to definitive histology. Staging was done according to the TNM classification.
LUS obtained good results in the evaluation of hepatic metastases, with a sensitivity of 100% versus 62.5% and 75% by preoperative diagnostic means and laparoscopy, respectively. Nodal metastases were diagnosed with a sensitivity of 94% versus 18% with preoperative staging and 6% with laparoscopy, but the method had a low specificity (53%). The therapeutic program was changed thanks to laparoscopy and LUS in 11 cases (33%). In four cases (12%), the planned therapeutic approach was changed after LUS alone.
The results obtained in this study demonstrate that LUS is an accurate and highly sensitive procedure in staging colorectal cancer, providing a useful and reliable diagnostic tool complementary to laparoscopy.
随着技术的迅猛发展，腹腔镜结肠切除术发展迅速。在大多数情况下，腹腔镜切除术用于治疗结直肠癌。腹腔镜手术中的术中分期受限。腹腔镜超声检查（LUS）是腹腔镜手术中唯一可真正替代手动触诊的方法。
我们评估了33例结直肠癌患者中LUS与术前分期及腹腔镜检查相比的诊断准确性。术前分期包括腹部超声、CT及内镜超声（用于直肠癌）。所有病例均进行了腹腔镜检查和LUS。术前和术中分期与最终组织学结果相关。分期依据TNM分类进行。
LUS在评估肝转移方面取得了良好结果，其敏感性为100%，而术前诊断方法和腹腔镜检查的敏感性分别为62.5%和75%。诊断淋巴结转移的敏感性为94%，术前分期为18%，腹腔镜检查为6%，但该方法特异性较低（53%）。11例（33%）患者因腹腔镜检查和LUS改变了治疗方案。4例（12%）患者仅在LUS检查后改变了计划的治疗方法。
本研究结果表明，LUS在结直肠癌分期中是一种准确且高度敏感的方法，是一种与腹腔镜检查互补的有用且可靠的诊断工具。
