腹腔镜超声结合内镜超声评估胰腺癌可切除性的临床价值

Combined Preoperative Endoscopic and Laparoscopic Ultrasound for Prediction of Surgical Resectability in Patients with Pancreatic Carcinoma

【目的】探讨腹腔镜超声(LUS)结合术前内镜超声(EUS)评估胰腺癌可切除性的临床价值。【方法】对2006年3月至2009年10月临床诊断为胰腺癌的56例患者先后行EUS及LUS检查,对EUS、LUS均判断肿瘤可以切除的患者行剖腹探查手术,最后证实确实可行根治性切除手术的患者,明确术前联合应用EUS、LUS评估胰腺癌可切除性的临床价值。【结果】56例患者中仅35.7%可行根治性切除手术,91.7%的不能接受切除手术的患者因EUS、LUS避免了剖腹探查;LUS判断肿瘤可切除的诊断特异性、正确性及阳性预测值分别达76.9%、90.3%及85.7%,明显高于单用EUS的63.9%、76.8%及60.6%,而EUS、LUS联合检查可进一步将诊断特异性和正确性提高到91.7%和94.4%。【结论】术前联合应用EUS、LUS可以显著提高胰腺癌可切除性评估的准确性,使单纯开腹探查手术减少到10%以下,具有重要的临床价值。

[Objective] The aim of this study was to evaluate the clinical value of combined preoperative endoscopic ultrasound（EUS） and laparoscopic ultrasound（LUS） for prediction of surgical resectability in the patients with pancreatic carcinoma.[Methods] From March 2006 to October 2009,56 patients diagnosed with pancreatic carcinoma were entered into this study.Patients were first examined with EUS followed by LUS,if EUS did not find any signs of non-resectability.[Results] Only patients with tumors found to be possibly resectable at EUS and LUS were offered exploratory operation.And the allocation of patients into possible resectability group by EUS and LUS were compared with the radical resection actually undertaken.In all,radical resection could be undertaken in only 35.7% patients.91.7% cases with non-resectable tumor avoided futile explorations because of EUS and LUS.The specificity,accuracy,and positive predictive value of EUS and LUS in identifying resectability was 63.9%,76.8%,60.6%,and 76.9%,90.3%,85.7%,respectively.But combined EUS and LUS improved the specificity and accuracy to 91.7% and 94.4%.[Conclusion] As a conclusion,combined EUS and LUS has a high predictive value for resectability in patients with pancreatic carcinoma and helps to reduce the number of futile explorations.