术中超声对早期诊断消化道肿瘤肝转移的价值

目的探讨术中超声对早期诊断消化道肿瘤肝转移的价值。方法应用术中超声对176例确诊为消化道恶性肿瘤患者行术中肝脏超声检查，并与术前经腹壁超声、CT肝脏扫描以及外科手术探查等进行对比观察，所有肝内转移病灶均经手术切除或穿刺活检组织学确诊。全部病例于术后随访。结果176例消化道肿瘤于手术时发现肝内转移43例(24.4%)，计81个结节。其中术中超声诊断率为97.7%，显著高于术前经腹壁超声的86.0%、CT扫描的79.1%和外科直接探查的69.8%(P＜0.05，P＜0.01)，尤其是对24个直径＜2cm的结节，术中超声、术前超声、CT扫描和外科探查的诊断率分别为95.8%、58.3%、41.7%和25.0%，术中超声显著优于其他方法（P＜0.01）。结论术中超声对早期诊断消化道肿瘤肝内转移有极高的敏感性，对提高消化道肿瘤外科手术的治愈率，延长患者生存率有重要价值。

Intraoperative ultrasonographic detection of liver metastasis from tumors of the digestive tract

Objective To ascertain the value of intraoperative ultrasonography to early detect liver metastasis from tumors of the digestive tract.Methods Intraoperative ultrasonography (US) of the liver was performed in 176 patients with confirmed diagnosis of cancer of the stomach and colon. All the nodules detected were either resected or needle biopsied for histological diagnosis. The results of the liver US were compared with those of pre operative trans abdominal US,CT scanning and intraoperative exploration.Results Liver metastasis was detected by intraoperative US in 43 of the 176 patients (24.4%), with a total of 81 nodules found. Liver metastasis was confirmed histologically in 42 of the 43 cases (97.7%), the frequency of which was significantly higher than that of preoperative transadominal US, CT scan and surgical exploration ( P <0.05, P <0.01). It was particularly superior for the detection of liver metastasis less than 2 cm in diameter.Conclusion intraoperative ultrasonography is sensitive enough to early detect tumors of the stomach and colon metastasized to the liver.