腹腔镜超声在胰腺壶腹部肿瘤分期诊断和治疗中的价值

目的 评价腹腔镜超声技术(LapUS)在胰腺和壶腹部癌肿分期诊断和治疗中的临床应用价值。方法 自1996年12月～1999年12月连续对46例怀疑胰腺和壶腹部肿瘤病人进行腹腔镜和腹腔镜超声分期诊断。并与术前影像学检查、手术中发现及术后标本病理学检查进行前瞻对比研究。着重检查肿瘤范围、周围血管侵犯、周围淋巴结转移、浆膜浸润和肝、邻近脏器转移；对可疑病变和肿大的淋巴结进行腹腔镜超声引导下穿刺活检。判断肿瘤切除性。结果 46例病人中。LapUS发现肿块性病灶44例，2例阻塞性黄疸确诊为壶腹部结石嵌顿排除肿瘤。44例肿块性病变中41例为恶性肿瘤，3例为炎性病变，肿瘤诊断正确率为93．2％。本组未发生腹腔镜和腹腔镜超声检查有关并发症。结论腹腔镜和腹腔镜超声检查应列为重要的分期诊断工具，剖腹探查前常规应用可明显提高诊断正确率、完善肿瘤分期诊断和可切除性判断。可避免不必要的剖腹探查术。在微创外科诊治中具有重要的临床应用价值。

Value of Laparoscopic Ultrasonography in Staging and Palliation of Pancreatic and Periampullary Malignancy

Objective To evaluate the value of laparoscopic ultrasonography (LapUS) in the diagnostic staging and palliation of peripancreatic malignancy. Methods Laparoscopic ultrasonography has been used from December 1996 to December 1999 in 46 consecutive patients with suspected peripancreatic malignancy, and was prospectively compared with other preoperative diagnostic imaging modalities, intraoperative findings and histopathology. We focused on detection of tumor extent , infiltration to surrounding vascular structure and metastases to peritoneum, liver and lymph nodes; biopsies of suspected metastatic lesions and enlarged lymph nodes were taken under laparoscopic or LapUS-guidance using biopsy forceps or core-cutting biopsy needles for judgment of tumor resectability. Results LapUS found tumor lesions in 44 out of 46 patients and another 2 cases of impacted stones in ampulla of Vater , and the correct diagnosis of malignancy was obtained by LapUS in 41 of 44 patients, with diagnostic accuracy of 93.2%. There were no intraoperativeor postoperative complications related to the laparoscopic procedure. Conclusion Laparoscopy with laparoscopic ultrasonography is an important component in the staging of pancreatic and periampullary tumors, and will improve diagnostic accuracy, optimize resectability, and avoid unnecessary laparotomy when routinely performed before exploration.