Amaç:İntraoperatif sonografinin, karaciğer tümörlü hastalarda teknik uygulama koşullarını, tanı ve tedaviye olan katkısını ortaya koymak. Gereç ve Yöntem: Preoperatif inceleme yöntemlerine göre opere edilebilir olarak değerlendirilen 93 karaciğer metastazı olgusu sonografi ile incelenmiştir. Hastalar operasyondan önce ultrasonografi, bilgisayarlı tomografi, anjiografi ve bazı olgularda sintigrafi ile değerlendirilmiş olup; intraoperatif sonografi bulguları, preoperatif inceleme sonuçları ve cerrahi bulgular ile karşılaştırılmıştır. Bulgular:Operasyonun gidişi 37 olguda (%40) değişmiştir. Yeni bulgular nedeniyle 14 olguya (%15) ek cerrahi girişim gerekirken, 7 olguda (%8) operasyon küçültülmüş, 16 olgu (%17) inoperabl bulunarak operasyon sonlandırılmıştır. Cerrahi gidişin değişme nedenini 10 (%11) olguda sadece intraoperatif sonografi, 10 (%11) olguda sadece cerrahi bulgular, 17 (%18) olguda ise her ikisi oluşturmuştur. Sonuç:Karaciğer metastazlarının doğru evrelendirilerek gereksiz cerrahinin önlenmesinde intraoperatif sonografinin, duyarlığı yüksek ve etkin bir inceleme yöntemi olduğu sonucuna varılmıştır. Genel olarak, hastaların üçte birinde intraoperatif sonografi, operasyon gidişini değiştirdiğinden; özellikle karaciğer rezeksiyonu uygulanan merkezlerde intraoperatif karaciğer sonografisi, rutin uygulama olarak önerilmiştir.
1. Foster JH, Ensminger WF. Treatment of metastatic
cancer to liver. Cancer: principles and practice of
oncology. Philadelphia, JB Lippincott Company, 1985;
2117-2121.
2. Bengmark S, Hafstorm L. The natural course of liver
cancer. Prog Clin Cancer 1978;7:195-201.
3. Foster JH: Survival after liver resection for secondary
tumors.Am J Surg 1978;135:389-392.
4. Wernecke K Rummeny E, Bongartz G, et al. Detection
of hepatic masses in patients with carcinoma:
Comperative sensitivities of sonography, CT, and MR
imaging.AJR 1991;157:731-736.
5. Sitzman JV, Coleman J, Pitt HA, et al. Preoperative
assesment of malignant hepatic tumors. Am J Surg
1990;159:137-141.
6. Machi J, Isomoto H, Kurohiji T, et. al. Accuracy of
intraoperative sonography in diagnosing liver
metastasis from colorectal cancer: evaluation with
postoperative follow-up results. World J Surg
1991;15:551-555.
7. Silverberg E, Boring CC, Squýres TS. Cancer statistics,
CA40, (1990), p:9.
8. Kronborg O. Screening for colorectal neoplasia.
Review and recommendations 1993; 155:3272-3278.
9. Ward BA., Miller LD, Frank AJ, et al. Prospective
evaluation of imaging studies in the detection of
colorectal metastases: Corelation with surgical
findings. Surgery 1989;105:180-185.
10. Boldrini G, Gaetano AM, Giovannini, et al. The systematic use of operative ultrasound for detection of
liver metastases during colorectal surgery. World J
Surg. 1987; 11:622-627.
11. Sheu J, Lee C, Sung J et al. Intraoperative hepatic
ultrasongraphy: an indispensable procedure in
resection of small hepatocellular carsinomas. Surgery
1985;97:542-548.
12. Kakudo N, Bandai Y, Imanýshý H et al. Management of
new hepatic nodules detected by intraoperative
ultrasound during hepatic resection for hepatocellular
carcinoma. Surgery 1996;119:634-639.
13. Machi J, Isomoto H, Yamashita Y, et al. The role of
ultrasound imaging during pancreatic surgery. Ann
Surg 1984;200:486-490.
14. Parker GA, Lawrence W, Horsley JS, et al.
Intraoperative ultrasonography in screening for liver
metastases from colorectal cancer: Comperative
accuracy with traditional procedures. Surgery
1987;101:678-682.
15. Sugarbaker PH. Surgical decision making for large
bowel cancer metastases to the liver. Radiology
1990;174:621-627.
16. Soyer P, Elias D, Zeitoun, et al. Surgical treatment of
hepatic metastases: Impact of intraoperative
sonography.AJR 1993;160:511-514.
17. Kane RA, Hughes LA, Cua EJ, et al. The impact of
intraoperative ultrasonography on surgery for liver
neoplasms. J Ultrasound Med 1994;13:1-5.
18. Bowerman RA, McCracken S, Silver TM, et al.
Abdominal and miscellaneous applications of
intraoperative ultrasound. Radiol Clin North Am
1985;23:107-112.
19. Gozetti G, Mazziotti A, Bolondi L, et al. Intraoperative
ultrasonography in surgery for liver tumors. Surgery
1986;99:523-529.
20. Rifkin MD, Rosato FE, Brunch HM, et. al.
Intraoperative ultrasound of the liver: an important
adjunctive tool for decision making in the operating
room.Ann Surg 1987;205:466-472.
21. Castaing D, Edmond J, Kustlinger F, et al. Utility of
operative ultrasound in management of liver tumors.
Ann Surg 1986;204:600-605
Intraoperative Sonography In Evaluation And Surgical Treatment of Liver Metastases
Purpose: The aim of this study was to evaluate the impact of intraoperative ultrasonography, on surgical decision making in patients with liver metastases. The technique of intraoperative ultrasonography also was discussed. Materials and Methods: intraoperative ultrasonography of the liver was performed in 93 patients operated for liver metastases. The patients were evaluated preoperatively by ultrasonography, computed tomography and in some cases by scintigraphy. intraoperative ultrasonography findings were compared with the results of preoperative imaging, surgical findings and the findings at surgery. Results: The surgical procedures were altered in 37 patients (40%). The procedure was extended in 14 patients (15%) and reduced in 7 patients (8%). Sixteen patients (17%) were found inoperable. The reason for the surgical modification was intraoperative ultrasonography alone in 10 patients (11%), surgical findings alone in 10 patients (11%), and a combination of both in 17 patients (18%). Conclusion: intraoperative ultrasonography is a precise diagnostic tool for staging the operability of liver metastases. Thus, unnecessary surgical procedures can be avoided. Totally, intraoperative ultrasonography altered the preoperative plan in one third of the patients and therefore is recommended as a routine procedure in connection with major liver surgery.
1. Foster JH, Ensminger WF. Treatment of metastatic
cancer to liver. Cancer: principles and practice of
oncology. Philadelphia, JB Lippincott Company, 1985;
2117-2121.
2. Bengmark S, Hafstorm L. The natural course of liver
cancer. Prog Clin Cancer 1978;7:195-201.
3. Foster JH: Survival after liver resection for secondary
tumors.Am J Surg 1978;135:389-392.
4. Wernecke K Rummeny E, Bongartz G, et al. Detection
of hepatic masses in patients with carcinoma:
Comperative sensitivities of sonography, CT, and MR
imaging.AJR 1991;157:731-736.
5. Sitzman JV, Coleman J, Pitt HA, et al. Preoperative
assesment of malignant hepatic tumors. Am J Surg
1990;159:137-141.
6. Machi J, Isomoto H, Kurohiji T, et. al. Accuracy of
intraoperative sonography in diagnosing liver
metastasis from colorectal cancer: evaluation with
postoperative follow-up results. World J Surg
1991;15:551-555.
7. Silverberg E, Boring CC, Squýres TS. Cancer statistics,
CA40, (1990), p:9.
8. Kronborg O. Screening for colorectal neoplasia.
Review and recommendations 1993; 155:3272-3278.
9. Ward BA., Miller LD, Frank AJ, et al. Prospective
evaluation of imaging studies in the detection of
colorectal metastases: Corelation with surgical
findings. Surgery 1989;105:180-185.
10. Boldrini G, Gaetano AM, Giovannini, et al. The systematic use of operative ultrasound for detection of
liver metastases during colorectal surgery. World J
Surg. 1987; 11:622-627.
11. Sheu J, Lee C, Sung J et al. Intraoperative hepatic
ultrasongraphy: an indispensable procedure in
resection of small hepatocellular carsinomas. Surgery
1985;97:542-548.
12. Kakudo N, Bandai Y, Imanýshý H et al. Management of
new hepatic nodules detected by intraoperative
ultrasound during hepatic resection for hepatocellular
carcinoma. Surgery 1996;119:634-639.
13. Machi J, Isomoto H, Yamashita Y, et al. The role of
ultrasound imaging during pancreatic surgery. Ann
Surg 1984;200:486-490.
14. Parker GA, Lawrence W, Horsley JS, et al.
Intraoperative ultrasonography in screening for liver
metastases from colorectal cancer: Comperative
accuracy with traditional procedures. Surgery
1987;101:678-682.
15. Sugarbaker PH. Surgical decision making for large
bowel cancer metastases to the liver. Radiology
1990;174:621-627.
16. Soyer P, Elias D, Zeitoun, et al. Surgical treatment of
hepatic metastases: Impact of intraoperative
sonography.AJR 1993;160:511-514.
17. Kane RA, Hughes LA, Cua EJ, et al. The impact of
intraoperative ultrasonography on surgery for liver
neoplasms. J Ultrasound Med 1994;13:1-5.
18. Bowerman RA, McCracken S, Silver TM, et al.
Abdominal and miscellaneous applications of
intraoperative ultrasound. Radiol Clin North Am
1985;23:107-112.
19. Gozetti G, Mazziotti A, Bolondi L, et al. Intraoperative
ultrasonography in surgery for liver tumors. Surgery
1986;99:523-529.
20. Rifkin MD, Rosato FE, Brunch HM, et. al.
Intraoperative ultrasound of the liver: an important
adjunctive tool for decision making in the operating
room.Ann Surg 1987;205:466-472.
21. Castaing D, Edmond J, Kustlinger F, et al. Utility of
operative ultrasound in management of liver tumors.
Ann Surg 1986;204:600-605