羽木 裕雄¹, 謝 暁燕　^{1, 2}, 杉山 政則^{1, 2}, 跡見 裕^{1, 2}

Hiroo HAGI¹, Xiao-Yan XIE^{1, 2}, Masanori SUGIYAMA^{1, 2}, Yutaka ATOMI^{1, 2}

¹杏林大学医学部第1外科, ²中山医科大学附属第一医院超音波科

¹First Department of Surgery, Kyorin University School of Medicine, ²Department of Ultrasonic Diagnosis, First Affiliated Hospital, Sun Yat-Sen University of Medical Sciences

キーワード : Intraoperative ultrasonography , Intraportal ultrasonography , Pancreatobiliary carcinoma, Transthoracic echocardiography, Ultrasound

Conventional preoperative imaging modalities can not reliably assess portal venous invasion by pancreatobiliary carcinomas. We thus evaluated usefulness of intraoperative ultrasonography (IOUS) and intraportal ultrasonography (IPUS) for detecting pancreatobiliary carcinomas and assessing portal venous invasion. We then compared our results with those obtained using other imaging modalities. Twenty-three patients who underwent tumor resection for pancreatobiliary carcinomas were studied: pancreatic carcinoma (10 patients), intraductal papillary tumor of the pancreas (3 patients), bile duct carcinoma (7 patients), and gallbladder carcinoma (3 patients). These patients underwent ultrasonography, endoscopic ultrasonography (EUS), computed tomography (CT), MR imaging, and angiography preoperatively, as well as IOUS and IPUS. Ultrasonography, EUS, CT, MR imaging, angiography, IOUS, and IPUS detected pancreatobiliary carcinomas in 78%, 90%, 70%, 85%, 38%, 100%, and 64% of the patients, respectively. Loss of echogenic vessel-parenchymal sonographic interface or presence of a tumor within the vessel lumen on IOUS and IPUS indicated portal venous invasion. IOUS (86%) and IPUS (86%) were more sensitive than ultrasonography (67%), EUS (67%), CT (57%), MR imaging (57%), and angiography (71%) in diagnosing portal venous invasion. IOUS is a convenient and the most accurate modality available for detecting pancreatobiliary carcinomas. IOUS and IPUS thus appear to be useful for diagnosing portal venous invasion.