术中超声在胰腺外科中的应用

谭石; 陈文

中国临床医学影像杂志 ›› 2012, Vol. 23 ›› Issue (2) : 85-87.

论著

术中超声在胰腺外科中的应用

谭石，陈文

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Intraoperative ultrasound in surgery of the pancreas

TAN Shi, CHEN Wen

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摘要

目的：探讨术中超声在胰腺外科手术中的应用，评价术中超声的临床价值。方法：回顾性分析2007年2月—2010年1月间我院胰腺外科应用CT、经腹超声及术中超声检查结果，并与手术病理对照。应用指征主要是术前诊断不清晰、定位不明确、解剖关系复杂或术中触诊与影像资料相矛盾的病例。结果：14例患者中胰岛素瘤4例，实性假乳头状瘤4例，3例为胰腺炎，1例为腺癌，1例囊肿术后取石，1例经术中穿刺证实未见明显占位而放弃手术。CT病变检出率92.3%（12/13），诊断正确率为71.4%（10/14）；经腹超声检出率为83.3%（10/12），正确率为53.8%（7/13）；所有病变均经术中超声检出，术中超声检出率及诊断正确率与CT相比有所提高，与术前经腹超声比较有明显统计学差异。腹腔镜手术中超声发现2例病变侵犯血管而转为开腹手术。结论：术中超声不仅能提高病变的显示率及诊断率，同时对指导术式选择也具有重要意义。

Abstract

Objective: To discuss the utilization of intraoperative ultrasound(IOUS) in pancreatic surgery and evaluate the clinical value. Methods: Imaging of CT, trans-abdominal ultrasound and IOUS in 14 cases of pancreatic surgery in our hospital from February 2007 to January 2010 were analyzed retrospectively. Surgical results were compared with pathological findings. Indications were mainly unclear preoperative diagnosis or location, complicated anatomy or contradiction between intraoperative palpation with the image data. Results: Fourteen cases included 4 cases of insulinoma, 4 cases of solid pseudopapillary tumor, 3 cases of pancreatitis, 1 case of adenocarcinoma, 1 case of pancreatic stone after cyst resection, 1 case with normal intraoperative biopsy result which gave up surgery. The detection rate of preoperative CT examination and transabdominal ultrasound was 92.3%(12/13) and 83.3%(10/12) respectively; and diagnostic accuracy was 71.4%(10/14) and 53.8%(7/13), respectively. All the lesions were detected by IOUS, with a better detection rate and better diagnostic accuracy compared with CT, and there was a significant difference between transabdominal ultrasound and IOUS. Laparoscopic surgery was changed to open surgery in 2 cases because of vascular invasion detected by IOUS. Conclusion: IOUS not only can improve detection and diagnostic rates of disease, but also guide surgical plan selection.