[The value of intraoperative ultrasonography during surgery for pancreatitis related changes of the pancreas].

The main purpose of this work was to examine the value of intraoperative ultrasonography (IOS) for decision-making in patients with complications of chronic pancreatitis and pancreatic adenocarcinoma. High-resolution intraoperative ultrasound scanning using B-mode real time (Capasee SSA-220A, Toshiba, Tokyo, Japan) and 7.5 MHz T-type transducer was performed in 48 patients (18 women and 30 men) treated at the Second Department of General Surgery between 1996 and 1998. The size, echogenicity and location of pancreatic lesions was studied, as well as the structure of liver, bile ducts and regional lymph nodes. The value of IOS was assigned to one of three categories: 1) very helpful--the scheduled operative procedure was modified in the light of IOS findings; 2) helpful--the operative procedure was carried out under IOS guidance; and 3) not helpful. The patients were divided into three groups basing on the histologic changes: Group I--26 patients operated for pancreatic carcinoma; group II--19 patients with cystic lesions and inflammatory tumors of the pancreas; group III--3 patients operated for preoperatively diagnosed pancreatic carcinoma not confirmed during surgery. In group I eight resections were performed, including five Whipple duodenopancreatectomies, two pancreatectomies, and one subtotal pancreatectomy. Very helpful information was obtained from IOS in four (16%) patients, helpful information in 11 (42%), not helpful in 11 (42%). Two nonpalpable masses were revealed by ultrasonography. In all cases the spread of the carcinoma to peripancreatic vessels: portal vein, superior mesenteric artery and inferior caval vein was correctly assessed (Figs. 1, 2). IOS provided mainly topographic information in group II, with very helpful and helpful data for 89% of the operations. Three cystic lesions in the inflammatory infiltrate and three hitherto undetected minor cysts were found. IOS facilitated drainage in 11 cases by reducing tissue trauma and operative time (Fig. 3). In six patients with suspected inflammatory lesions ultrasound served to guide needle biopsy. In group III the information was of diagnostic value. All patients in this group were intraoperatively diagnosed with extrapancreatic primary neoplasm spreading to the hepatoduodenal ligament. IOS served to inert a prosthesis of the common bile duct in one patient. Overall, IOS was very helpful for decision-making in 22.9% and helpful in 50% of the procedures (Tab. 1).