腹腔镜超声扫描在判断胰头癌切除中的价值

The application of laparoscopic ultrasonography in judging the resectability of cancer of pancreatic head

目的 探讨腹腔镜及其超声扫描技术 (LUS)在判断胰头癌可切除中的价值。方法 对2 2例临床已确诊为胰头癌的病人在剖腹探查手术前 ,采用腹腔镜超声进行前瞻性的肿瘤分期 ,明确肝、腹膜有无微小转移 ,有无局部的血管侵犯 (门静脉、肠系膜上动静脉、主动脉及下腔静脉 )。结果 本组发现肝表面及腹膜转移癌灶 3例 ,肝内转移灶 1例 ,超声引导穿刺证实为胰腺炎 1例 ,从而避免了开腹手术 ,余 17例中 8例发现腹腔、腹膜后及网膜有肿大淋巴结与局部血管或肿瘤本身与局部血管有侵犯 ,其中 2例发现门静脉血栓 ,余 9例提示可以手术切除。 17例病人进行剖腹探查 ,8例成功进行胰十二指肠切除术。结论 腹腔镜超声扫描可以较为准确的判断胰头癌切除的可能性 。

Objective To explore the clinical application and value of laparoscopy and laparoscopic ultrasonography (LUS) in judging the resectability of pancreatic head cancer. Methods Employed LUS as a prospective diagnosis of tumor staging before exploratory laparotomy in 22 patients with defined diagnosis of pancreatic head cancer to identify the hepatic, peritoneal metastases or local vascular invasion (portal vein, superior mesenteric vessel, aorta, inferior vena cava). Results Among 22 patients undergoing laparoscopy and LUS, peritoneal or surface liver metastases were found in 3 patients, hepatic parenchyma metastases in 1 patient, and 1 patient was proved to be pancreatitis by percutaneous ultrasound-guided biopsy. Laparotomy was avoided in the above 5 patients. In the remained 17 patients, we discovered hypertrophic lymph node in peritoneal cavity, retroperitoneum, omentum or tumor invasion of local vessels in 8 patients, including 2 patients with portal vein thrombus. It was revealed that tumors in the other 9 patients were resectable. 17 patients were performed exploratory laparotomy, pancreaticoduodenectomy was successful in 8 patients. Conclusions Laparoscopy and LUS can relatively precisely estimate the resectability of cancer of pancreatic head, so it may be employed as a routine examination before exploratory laparotomy.