腹腔镜在胰腺肿瘤诊断和分期中的价值

目的:总结胰腺肿瘤剖腹手术前先行腹腔镜探查的价值。方法:对12例经B超和CT诊断或怀疑为胰腺肿瘤的病人,在剖腹手术前先行腹腔镜探查,其中2例联合使用腹腔镜超声检查(LUS)。结果:1例CT诊断疑为胰头肿瘤伴少量腹水者,腹腔镜明确为原发性腹膜炎,作冲洗引流而愈。2例影像学检查见胰体尾增厚,怀疑胰腺肿瘤者,腹腔镜检查未见明显异常,再作LUS检查,1例为胰腺囊肿,另1例未见异常。9例腹腔镜检查确诊为胰腺恶性肿瘤病人中,3例明确已有远处转移,从而避免了开腹;另6例腹腔镜探查提示可以切除,结果其中1例由于肠系膜血管被肿瘤包绕而无法切除,余5例(5/9=55.6%)进行了根治性切除。腹腔镜探查在评估胰腺癌不可切除性的敏感性为75%,特异性为100%,阳性预测值为100%,阴性预测值为83.3%。结论:腹腔镜探查可发现影像学检查不能发现的腹膜转移,结合腹腔镜超声检查可提高胰腺肿瘤诊断、分期的准确性,使部分病人避免了不必要的剖腹手术。

The value of laparoscopy and laparoscopic ultrasonography in the diagnosis and staging of pancreatic cancer before laparotomy

Objective To assess the value of laparoscopy and laparoscopic ultrasonography (LUS) in the diagnosis and staging of pancreatic cancer before laparotomy. Methods Twelve patients suspected of pancreatic neoplasm by ultrasounography and CT scan underwent laparoscopic examination before laparotomy. Laparoscopic ultrasonography was also performed in the 2 most recent patients. Results By laparoscopy alone, 1 patient was diagnosed primary peritonitis and treated accordingly; 2 patients received simultaneously LUS, which showed that one had pancreatic cyst and the other had no lesion what so ever was normal. Of 9 patients with pancreatic cancer, 3 were found to have distant metastasis; the other 6 underwent laparotomy, 1 of which was found unresectable with the turmor encasing the superior mesenteric vein, and 5 of them were eventually successfully resected. The sensitivity of laparoscopy in determining unresectability was 75%, the specificity 100%, the positive predictive value being 100% and the negative predictive value 90%. Conclusions Laparoscopy and LUS have improved the accuracy of the diagnosis and staging in pancreatic neoplasm, and help to avoid unnecessary laparotomy for unresectable cases.