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目的 探讨术中超声对早期诊断消化道肿瘤肝转移的价值。方法 应用术中超声对176例确诊为消化道恶性肿瘤患者行术中肝脏超声检查 ,并与术前经腹壁超声、CT肝脏扫描以及外科手术探查等进行对比观察 ,所有肝内转移病灶均经手术切除或穿刺活检组织学确诊。全部病例于术后随访。结果 176例消化道肿瘤于手术时发现肝内转移 43例 (2 4.4% ) ,计 81个结节。其中术中超声诊断率为 97.7% ,显著高于术前经腹壁超声的 86 .0 %、CT扫描的 79.1%和外科直接探查的 6 9.8%(P <0 .0 5 ,P <0 .0 1) ,尤其是对 2 4个直径 <2cm的结节 ,术中超声、术前超声、CT扫描和外科探查的诊断率分别为 95 .8%、5 8.3%、41.7%和 2 5 .0 % ,术中超声显著优于其他方法 (P <0 .0 1)。结论 术中超声对早期诊断消化道肿瘤肝内转移有极高的敏感性 ,对提高消化道肿瘤外科手术的治愈率 ,延长患者生存率有重要价值。
Objective To investigate the value of intraoperative ultrasound in early diagnosis of hepatic metastasis of alimentary tract tumors. Methods Intraoperative ultrasound was performed on 176 patients diagnosed as gastrointestinal malignant tumors by intraoperative ultrasound and compared with preoperative abdominal ultrasound, CT liver scan and surgical exploration. All intrahepatic metastatic lesions were surgically treated Resection or biopsy histologically confirmed. All cases were followed up. Results In 176 cases of gastrointestinal tumors, 43 cases (24.4%) had intrahepatic metastasis at the time of surgery, accounting for 81 nodules. Among them, the rate of intraoperative ultrasound diagnosis was 97.7%, which was significantly higher than that of preoperative abdominal ultrasound 86.0%, CT scan 79.1% and surgical direct exploration 68.8% (P <0.05, P <0. 0 1), especially for 24 nodules <2 cm in diameter, the diagnostic rates of intraoperative ultrasound, preoperative ultrasound, CT scan and surgical exploration were 95.8%, 53.3%, 41.7% and 25.0% respectively %, Intraoperative ultrasound was significantly better than other methods (P <0.01). Conclusion Intraoperative ultrasound is very sensitive to the early diagnosis of intrahepatic metastasis of digestive tract tumors and is of great value in improving the cure rate and prolonging the survival rate of patients with gastrointestinal cancer.