Laparoscopic ultrasonography for staging of gastrointestinal malignancy.
Laparoscopic ultrasonography for staging of gastrointestinal malignancy.
复制标题
腹腔镜超声检查用于胃肠道恶性肿瘤的分期。
DOI：
10.3109/00365529609094730
复制
发表时间：
1996
期刊：
影响因子：
--
通讯作者：
H. Obertop
中科院分区：
文献类型：
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作者：
D. Gouma;L. D. de Wit;E. N. V. Nieveen van Dijkum;O. V. van Delden;W. Bemelman;E. Rauws;J. V. van Lanschot;H. Obertop
背景
诊断性腹腔镜检查已被频繁地用作不同胃肠道恶性肿瘤的术前分期程序。然而，对腹部实体器官和腹膜后长入或淋巴结转移的检测的评估是有限的。最近的发展，腹腔镜超声检查，可能会增加这些病变的术前评估，从而进一步提高术前分期。
方法
自1993年以来，诊断性腹腔镜联合腹腔镜超声检查已被作为一种额外的诊断程序，在患者谁已经选择了不同的胃肠道恶性肿瘤的根治性切除术。在这项前瞻性研究中，将常规检查后的分期与腹腔镜检查后的肿瘤分期进行了比较。所有患者均接受了剖腹探查术，组织学证实转移/向内生长的患者除外。
结果
对于食管癌和贲门癌患者（n = 56），17%的患者术前分期改变，但仅5%的患者可避免剖腹手术（对于贲门肿瘤患者亚组，11%的患者可避免剖腹手术）。腹腔镜检查期间的其他发现表明，55%（n = 44）的原发性肝肿瘤、肝转移瘤或近端胆管肿瘤患者可以避免剖腹手术。对于胰头肿瘤患者（n = 73），40%的肿瘤术前分期发生了变化; 26%的治疗策略发生了变化，20%的患者可以避免剖腹手术。
结论
腹腔镜联合腹腔镜超声检查在胃肠道恶性肿瘤的分期中是有效的（更准确），特别是对于肝、胆和胰腺肿瘤患者。不同胃肠道恶性肿瘤的术前肿瘤分期在15 - 60%之间变化，5- 55%可以避免剖腹手术。该程序高度依赖于操作员，并具有学习曲线。
BACKGROUND
Diagnostic laparoscopy has been used frequently as a preoperative staging procedure for different gastrointestinal malignancies. The assessment of solid abdominal organs and retroperitoneal ingrowth or detection of lymph-node metastasis is limited, however. A recent development, laparoscopic ultrasonography, will probably increase the preoperative evaluation of these lesions and thus further improve the preoperative staging.
METHOD
Since 1993 diagnostic laparoscopy combined with laparoscopic ultrasonography has been performed as an additional diagnostic procedure in patients who have already been selected for curative resection of different GI malignancies. In this prospective study, staging after conventional work-up is compared with the tumour stage after laparoscopy. All patients underwent exploratory laparotomy except those with histologically proven metastases/ingrowth.
RESULTS
For patients with cancer of the esophagus and gastric cardia (n = 56) the preoperative stage was altered in 17% but laparotomy could only be avoided in 5% (for a subgroup of patients with a tumour of the gastric cardia laparotomy was avoided in 11%). Additional findings during laparoscopy showed that laparotomy could be avoided in 55% of the patients (n = 44) with primary liver tumours, liver metastasis or proximal bile duct tumours. For patients with pancreatic head tumours (n = 73) the preoperative stage of the tumor changed in 40%; the strategy of treatment was changed in 26% and laparotomy could be avoided in 20%.
CONCLUSIONS
Laparoscopy combined with laparoscopic ultrasonography is effective (more accurate) in the staging of gastrointestinal malignancies, in particular for patients with liver, biliary and pancreatic tumours. The preoperative tumour stage changed between 15 and 60% for the different gastrointestinal malignancies and laparotomy could be avoided in 5-55%. The procedure is highly operator-dependent and has a learning curve.