腹腔镜及其超声扫描判断胰头癌切除率的临床应用及意义

CLINICAL APPLICATION AND SIGNIFICANCE OF LAPAROSCOPY AND 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)在判断胰头癌切除率中的应用及其价值。方法 :对 2 2例临床已确诊为胰头癌的病人在行剖腹探查手术前 ,采用腹腔镜超声进行前瞻性的肿瘤分期诊断 ,借此明确肝、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 :2 2例病人经腹腔镜及其超声扫描发现肝表面及腹膜转移癌灶 3例 ,肝内转移灶 1例 ,超声引导穿刺活检证实为胰腺炎 1例 ,上述 5例避免了开腹手术 ,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例腹腔镜超声检查提示可以手术切除。 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 :腹腔镜及其超声扫描可以较为准确的判断胰头癌切除的可能性 ,可以避免不必要的剖腹探查以及由此而带来的并发症 ,有望成为胰头癌剖腹探查术前常规检查方法。

Objective: To explore the clinical application and value of laparoscopy and laparoscopic ultrasonography (LUS)in judging the resectability of cancer of pancreatic head.Methods:Employed LUS as a prospective diagnosis of tumor staging before exploratory laparotomy in 22 patients with defined diagnosis of cancer of pancreatic head to identify whether the liver and peritoneum had small metastases or local vascular invasion (portal vein,superior mesenteric vessel,artery,inferior vena cava).Results:Among 22 patients with laparoscopy and LUS,we detected peritoneal or surface liver metastases in 3 patients,hepatic parenchyma metastases in 1 patient ,and 1patient was proved to be pancreatitis by percutaneous biopsy under ultrasound navigating.Laparotomy was avoided in the above 5 patients.In the remained 17 patinets,we discovered hypertrophic lymph node or tumor invasion of local vessels in peritoneal cavity,retroperitoneum,omentum in 8 patients,including 2 patients with portal vein thrombus ,the last 9 patients were revealed resectable based on LUS.Seventeen patients were performed exploratory laparotomy,pancreaticoduodenectomy was successful in 8 patients .Conclusions:Laparoscopy and LUS can relatively precisely estimate the possibility of resection of cancer of pancreatic head ,and prevent unnecessary exploratory laparotomy and its complications,so it may be employed as a routine examination before exploratory laparotomy.