中国实用外科杂志

中国实用外科杂志

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腹腔镜探查活检术在局部进展期胰腺癌诊治中应用分析

林贤超，黄鹤光，陈燕昌，陆逢春，林荣贵，杨媛媛，王丛菲，方海宗     

  1. 福建医科大学附属协和医院基本外科，福建福州 350001
  • 出版日期:2020-11-01 发布日期:2020-11-23

  • Online:2020-11-01 Published:2020-11-23

摘要： 目的    探讨腹腔镜探查活检术在局部进展期胰腺癌（LAPC）诊断和治疗中的应用价值。方法    回顾性分析2017年1月至2020年6月福建医科大学附属协和医院基本外科收治的65例接受腹腔镜探查活检术的LAPC病人的临床资料，包括临床表现、血清肿瘤标记物、影像学检查、术中情况和术后情况等。结果    所有65例术前诊断为LAPC的病人的术中快速冰冻切片病理学检查结果均诊断为腺癌，包括胰腺穿刺活检51例（78.5%）、腹膜活检（腹壁、大网膜、肠系膜表面结节）8例（12.3%），肝脏活检3例（4.6%）和区域淋巴结活检3例（4.6%）。11例（16.9%）病人在术中探查时发现存在隐匿性转移，包括3例肝转移和8例腹膜转移。所有病人术后无出血、腹腔感染、胰瘘等并发症。65例病人中有50例（76.9%）在活检术后接受了化疗，剔除5例合并旁路手术病人（一般术后2周以上接受化疗）外，手术与化疗之间的中位间隔时间为3 d。结论    对术前影像学评估为LAPC的病人行腹腔镜探查活检术安全且有效，还可发现隐匿性转移和缩短术后化疗等待时间，腹腔镜探查活检术可以作为LAPC获取病理学诊断和准确分期的常规方法之一。

关键词: 胰腺癌, 腹腔镜探查, 活检, 隐匿性转移, 化疗

Abstract: Application of laparoscopic exploration and biopsy in locally advanced pancreatic cancer        LIN Xian-chao, HUANG He-guang, CHEN Yan-chang, et al.Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
Corresponding author: HUANG He-guang, E-mail：heguanghuang2@163.com
Abstract    Objective    To explore the value of laparoscopic exploration and biopsy in the diagnosis and treatment of locally advanced pancreatic cancer (LAPC). Methods    The clinical data of 65 patients with LAPC underwent laparoscopic exploration and biopsy from January 2017 to June 2020 in Fujian Medical University Union Hospital were analyzed retrospectively, including clinical manifestations, serum tumor markers, imaging examinations, intraoperative and postoperative parameters. Results    All 65 patients radiographically defined LAPC were pathologically diagnosed with adenocarcinoma by intraoperative frozen section, including 51 cases of pancreatic needle biopsy (78.5%), 8 cases of peritoneal biopsy (12.3%), 3 cases of liver biopsy (4.6%) and 3 cases of regional lymph node biopsy (4.6%). Occult metastasis was found in 11 patients (16.9%), including 3 liver metastases and 8 peritoneal metastases. No postoperative complications such as bleeding, abdominal infection or pancreatic fistula occurred in all patients. Among the 65 patients, 50 (76.9%) received chemotherapy after biopsy. The median interval between surgery and chemotherapy was 3 days, excluding 5 patients with bypass operation (generally receiving chemotherapy more than 2 weeks after the operation). Conclusion    Laparoscopic exploration and biopsy is safe and effective for patients with radiographically defined LAPC. It can detect occult metastasis and shorten the waiting time for postoperative chemotherapy. Laparoscopic exploratory biopsy can be used as one of the conventional methods for obtaining pathological diagnosis and accurate staging of LAPC.

Key words: pancreatic cancer, laparoscopic exploration, biopsy, occult metastasis, chemotherapy