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在美国,相当一部分胃癌患者已属进展期,并存在着腹腔内转移,姑息性手术虽能缓解癌肿造成的梗阻或出血,却无助于延长生存期。目前的影象学检测手段尚不能令人满意,大多数转移病例是在手术时才被发现。腹腔镜检查则有助于术前诊断腹腔内转移的程度。1990年12月至1995年12月,111例术前经影像等检查认为无腹腔内转移的胃癌病例接受了术前腹腔镜检查,这大约是Sloan Kettering纪念癌症中心同期收治胃癌病例总数的15％。腹腔镜检查在全麻下进行,仔细检查肝、膈、浆膜面、腹膜、网膜、肠道、肠系膜和盆腔。并在左右肋缘下各穿刺一孔,以协助探查淋巴结,需要时行超声波检查或活检。111例中1例因为过去手术粘连致使腹腔镜探查失败,7例未再接受手术。其余103例中,腹腔镜判断为M_0者71例,得到手术证实65例,余6例为假阴性实为M_1,腹腔镜判断为M_1者32例,均得到活检或手术证实。腹腔镜诊断腹腔内转移的灵敏度为84％,特异度为100％,分期的准确度达到94％。腹腔镜检查发现的71例腹腔内转移患者中,腹膜转移占72％,肝转移占9％,远处淋巴
In the United States, a considerable proportion of patients with gastric cancer have been in advanced stages, and there is intra-abdominal metastasis. Palliative surgery can relieve obstruction or bleeding caused by cancer but does not help to prolong survival. The current video detection methods are not yet satisfactory, and most cases of metastases were discovered at the time of surgery. Laparoscopy is helpful for preoperative diagnosis of intra-abdominal metastases. From December 1990 to December 1995, 111 cases of precancerous gastric cancers that were considered to have no intraperitoneal metastases were subjected to preoperative laparoscopy, which was approximately 15% of the total number of cases of gastric cancer treated by the Sloan Kettering Memorial Cancer Center during the same period. . Laparoscopy was performed under general anesthesia and the liver, sputum, serosa, peritoneum, omentum, intestine, mesentery, and pelvis were carefully examined. A hole is punctured under the right and left ribs to assist in the exploration of lymph nodes. Ultrasound or biopsy is needed. One of the 111 cases failed due to laparoscopic exploration due to past surgical adhesions, and 7 cases had no further surgery. Among the remaining 103 patients, 71 patients were diagnosed as M_0 by laparoscopy. Sixty-five cases were confirmed by surgery. The remaining 6 cases were false-negative M1, and 32 cases were judged as M1 by laparoscopy. All were confirmed by biopsy or surgery. The sensitivity of laparoscopic diagnosis of intra-abdominal metastasis was 84%, specificity was 100%, and the accuracy of staging was 94%. Among the 71 patients with intra-abdominal metastases found by laparoscopy, peritoneal metastasis accounted for 72%, liver metastasis accounted for 9%, distant lymph nodes.