可切除胰头壶腹部癌术中诊断方法比较

Evaluation of Intraoperative Means in the Diagnosis of Caroinoma of Pancreatic Head and Periampullary Region

对６２例胰、十二指肠切除术者，术中不同方法诊断可切除胰头、壶腹部癌的有效性进行了回顾。胰周淋巴结活检的阳性率为２０％，诊断有效性最低。细针穿刺抽吸活检（ＦＮＡＢ）诊断胰头癌的阳性率为７１．４３％，而胰切取活检阳性率仅为４０％。两者比较，ＦＮＡＢ诊断胰腺癌更有意义。经十二指肠切开活检，结合胆总管刮取活检常能使壶腹部癌的诊断获得满意结果。临床诊断应主要用于术中怀疑胰腺癌，而获得其组织学诊断又有一定困难的病人。文中对避免临床判断失误的要点进行了讨论。

Sixty-two consecutive patients who underwent pancreatoduodenal resection were reviewed to evaluate diagnostic accuracy of resectable carcinoma of the pancreatic head and periampullary region made intraoperatively by various means.Lymph node biopsy in area nearby the head of the pancreas was found to be Positive in 20%,resulted in a low yield of tumor presence for diagnosis.Fine needle aspiration blopsy(FNAB)was positive in 71.43%,and incisional biopsy only in 40%in patients having carcinoma of the head of the pancreas.It is suggested that FNAB is more valuable for diagnosis of the pancreatic cancer as compared with incisionalbiopsy.More often than not combination of duodenotomy with open biopsy or with scraping procedure of distal common bile duct resulted in higher likelihood in obtaining accurate diagnosis for periampullary malignancy.