Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer
Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer
复制标题
腹腔镜和腹膜细胞学在胰腺癌分期中的进一步经验
DOI：
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发表时间：
1995
影响因子：
9.6
通讯作者：
A. Warshaw
中科院分区：
文献类型：
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作者：
C. Castillo;D. Rattner;A. Warshaw
114例胰腺癌患者在计算机断层扫描中没有转移性疾病的迹象，他们接受了腹腔镜检查。27例（24%）患者存在腹腔内扩散。远端胰腺肿瘤（25例中11例，44%）的转移率是胰头肿瘤（89例中16例，18%）的2.4倍（P < 0.05）。27例转移患者均未接受进一步手术。在87例无转移性扩散的患者中，42例经血管造影发现有血管侵犯，并给予放疗。手术探查的40例患者中有30例被切除；其余10例中有2例腹腔扩散，腹腔镜检查未发现（假阴性率为7%）。94例患者在腹腔镜检查时行腹膜冲洗细胞学检查；细胞学检查呈阳性的有16例（17%）。细胞学阳性与可见的肝脏或腹膜转移之间存在显著相关性（22例有转移的患者中有10例，而72例无转移的患者中有6例，P < 0.001）。6例患者（8%）细胞学阳性，无明显转移，但没有可切除的疾病。
A total of 114 patients with pancreatic cancer and no evidence of metastatic disease by computed tomography underwent laparoscopy. Intra‐abdominal spread was present in 27 patients (24 per cent). Metastases were 2·4 times more common in tumours of the distal pancreas (11 of 25, 44 per cent) than in pancreatic head tumours (16 of 89, 18 per cent) (P < 0·05). None of the 27 patients with metastases underwent further surgery. Of the 87 patients without metastatic spread, 42 were found to have vascular invasion by angiography and were offered radiation therapy. Thirty of 40 patients explored surgically were resected; two of the remaining ten had peritoneal spread that had been missed at laparoscopy (false‐negative rate of 7 per cent). Cytological examination of peritoneal washings was performed in 94 patients at the time of laparoscopy; cytology was positive in 16 (17 per cent). There was a significant correlation between positive cytology and presence of visible liver or peritoneal metastases (ten of 22 with metastases versus six of 72 without, P < 0·001). Positive cytology was present in six patients (8 per cent) without visible metastases, but none had resectable disease.