腹腔镜在恶性腹膜间皮瘤诊断中的应用50例分析

目的：探讨恶性腹膜间皮瘤的腹腔镜表现及临床应用价值。方法：回顾性分析50例恶性腹膜间皮瘤的腹腔镜表现，并于8例腹膜转移癌及5例结核性腹膜炎腹腔镜下表现对比分析，与50例患者剖腹手术后的病理对比分析。结果：恶性腹膜间皮瘤腹腔镜下表现腹膜壁层和胃肠浆膜面散在分布灰白色小结节大小不一，壁层腹膜可见厚薄不均的饼锑样增厚。腹膜转移癌及结核性腹膜炎腹腔镜下表现相似。并与剖腹探查术后诊断一致。结论：腹腔镜活检是恶性腹膜间皮瘤最简单有效的诊断方法。     

超声对大网膜良恶性病变的诊断价值

目的探讨超声对大网膜良恶性病变的诊断价值。方法观察62例大网膜增厚患者的超声表现,与超声引导下穿刺活检结果进行对比分析。结果 62例患者中,结核性腹膜炎36例,腹膜假性黏液瘤5例,转移性腺癌18例,恶性间皮瘤2例,非霍奇金淋巴瘤1例。增厚大网膜良性病变表现以高回声、块状增厚及0级血流为主,恶性病变以低回声、结节状及Ⅲ级血流为主,二者比较差异均有统计学意义(P﹤0.05)。结论大网膜良恶性病变声像图特点存在明显差异,超声检查有助于二者的鉴别诊断,具有重要临床价值。     

腹膜间皮瘤的超声诊断价值

目的：分析腹膜间皮瘤的超声声像图特征，探讨超声对腹膜间皮瘤的诊断价值。方法：对23例腹膜间皮瘤的超声声像图及其中9例的彩色多普勒检查结果进行分析和总结，并将其声像图表现与手术及病理诊断相对照。结果：腹膜间皮瘤的超声声像图表现为：18例探及腹腔或盆腔肿块，回声不均匀，部分肿块内可见不规则暗区；腹膜弥漫性层状或结节状增厚11例(其中6例合并腹腔肿块)，腹水17例。彩色多普勒显像示肿块内较丰富的血流信号。结论：超声检查结合临床对本病可做出初步诊断。     

间皮瘤声像图特征

目的运用彩色多普勒超声回顾性分析间皮瘤的声像图特征。方法分析经手术确诊病理证实16例间皮瘤临床表现、多普勒超声所见。结果16例间皮瘤患者7例胸膜间皮瘤、9例腹膜间皮瘤。7例胸膜间皮瘤均为良性,9例腹膜间皮瘤4例良性、5例恶性。声像图特征：良性胸膜间皮瘤表现为局限性及弥漫性改变,伴有不同程度胸腔积液。局限性胸膜间皮瘤为囊性及中—强回声实性结节,边界清楚;弥漫性胸膜间皮瘤表现为网状结构,胸腔内多个分隔回声带分成大、小不等房腔,均与胸膜相连。腹膜间皮瘤表现为大量腹水伴肠粘连,腹膜常显示弥漫性或局限性增厚,典型腹膜间皮瘤为腹膜呈网状结构,表面有多个分隔回声带分成大、小不等房腔,与腹腔脏器相连。结论胸、腹膜间皮瘤从临床症状到超声图像均无特异性,因此遇见顽固性胸、腹水病例需提高警惕,必要时作胸、腹膜活检或剖腹探查确诊,以便早期治疗。     

腹膜恶性间皮瘤超声声像图与CT对比分析(附22例报道)

目的探讨超声和CT对腹膜恶性间皮瘤的诊断价值。方法回顾性分析经超声引导下腹膜穿刺活检证实的22例腹膜恶性间皮瘤的超声声像图与CT表现。结果超声对增厚腹膜的显示率高于CT,且超声对腹膜病变的定位准确度为100%(22/22)。CT对受累肠系膜的显示优于超声。结论超声与CT对腹膜恶性间皮瘤的显示各有优势,超声引导下腹膜活检为本病确诊提供金标准。     

超声显像对原发性腹膜恶性间皮瘤的诊断价值

目的：对照手术病理,分析原发性腹膜恶性间皮瘤超声显像的表现,方法：对照超声图像,回顾性总结8例经手术和尸解证实的原发性腹膜恶性间皮瘤病例,结果：声像图特点为：（1）壁层腹膜弥漫增厚似胎儿胎盘,脏层腹膜增厚常见消化道,充气肠袢被增厚腹膜包裹及粘连形成较大肿块,呈假肾征声像。（2）中－大量腹水。在超声引导下用自动活检枪取材病检效果好,结论：超声显像对该肿瘤诊断与鉴别诊断很有价值。     

高频超声诊断恶性腹膜间皮瘤17例分析

目的探讨高频超声对腹膜恶性间皮瘤的诊断价值。方法对17例恶性腹膜间皮瘤声像图特点进行分析总结,并与手术病理对照。结果腹膜恶性间皮瘤声像图表现为壁层腹膜不规则增厚9例,脏层腹膜受侵、包绕肠管形成假肾样包块5例,肠系膜和大网膜受侵形成＂饼样＂肿块3例,腹水17例。结论高频超声对腹膜恶性间皮瘤诊断具有重要实际意义。     

超声诊断结核性腹膜炎价值探讨

目的探讨结核性腹膜炎患者的声像图特点,以提高对该病的诊断水平。方法分析76例结核性腹膜炎患者声像图特点,病例均经临床综合检查及抗结核治疗有效而确诊。结果腹水、腹膜增厚、肠管粘连是结核性腹膜炎的基本表现,可总结为单纯腹水型,团块型,腹膜、肠壁增厚型。结论超声检查对结核性腹膜炎的诊断具有重要意义,可以作为结核性腹膜炎首选检查方法之一。     

腹膜间皮瘤声像图特征

目的 探讨腹膜间皮瘤的声像图表现及血流信号特征.方法 分析经手术确诊病理证实的9例腹膜间皮瘤的彩色多普勒超声表现.结果 9例腹膜间皮瘤患者中,4例良性,5例恶性.声像图特征:腹膜间皮瘤表现为大量腹水伴肠粘连,腹膜常显示弥漫性或局限性增厚,典型腹膜间皮瘤为腹膜呈网状结构, 表面有多个分隔光带分成大、小不等房腔;或表现为腹腔肿块以及腹腔内液性暗区伴不规则、断续的纤维素样光带.腹膜血流不丰富.结论 腹膜间皮瘤的声像图表现无明显特异性,遇见顽固性腹水病例需提高警惕,必要时作腹膜活检或剖腹探查确诊.     

超声对恶性腹膜间皮瘤的诊断价值

目的探讨超声对恶性腹膜间皮瘤(MPM)的诊断价值。方法 19例MPM患者,分析其声像图特征,评价超声对其诊断的可行性和准确性。结果 19例均可见腹膜病变增厚,位于大网膜8例,壁层腹膜6例,脏层腹膜5例;17例为"饼"样腹膜增厚,11例呈低回声,18例病变内部回声均匀,19例均见腹腔积液。结论超声可显示MPM的形态学特征,但难以做出明确诊断,需要在超声引导下经皮穿刺活检以明确诊断。     

不明原因腹水诊断中腹腔镜检查的应用价值

目的探讨腹腔镜检查在不明原因腹水诊断中的应用及价值。方法对42例不明原因腹水患者的腹腔镜探查及活检病理结果进行回顾性分析。结果 42例患者全部诊断明确,其中腹腔结核24例;腹腔恶性肿瘤16例,11例为转移性腺癌,5例为腹膜恶性间皮瘤;肝硬化2例。结论腹腔镜检查对不明原因腹水是一种安全、准确的诊断方法。     

弥漫性恶性腹膜间皮瘤超声与病理分析

目的再探讨超声对恶性腹膜间皮瘤的诊断要点。方法总结分析15例超声引导下介入活检病理诊断为恶性腹膜间皮瘤的超声资料。结果15例间皮瘤壁层腹膜厚薄不均，边界不整齐；腹膜线连续性中断，肿块部位回声低；网膜呈饼状不均性增厚，质硬感，边缘不整齐；超声引导下活检易取材，质硬，网膜不随针的提插而移动；CDFI：肿块内血流较丰富，11例RI〈0．60，4例RI〉0．60；病理：12例为上皮型，3例为腺管乳头型。结论弥漫性恶性腹膜间皮瘤有一定的超声特点，结合超声引导下活检能基本做出对该病的诊断与鉴别诊断。     

Tumors of serosal tissue origin

Primary serosal neoplasms demonstrate a wide spectrum of growth patterns and biologic aggressiveness. The adenomatoid tumor is uniformly benign, whereas the diffuse malignant mesothelioma pursues a downhill clinical course, rapidly leading to fatality. The cystic peritoneal mesothelioma occupies an intermediate position characterized by persistent and/or recurrent disease but without progression to death. The distinction of an epithelial mesothelioma from metastatic adenocarcinoma remains a challenging problem. In the vast majority of cases, this can be accomplished by combining routine histochemistry, immunocytochemistry, and electron microscopy. The absence of epithelial mucins and nonreactivity with antibodies to CEA strongly favor mesothelioma. Ultrastructurally observed long, thin, sinuous surface microvilli without a glycocalix, well-developed desmosomes, and abundant tonofilaments add further support for a primary serosal neoplasm. The sarcomatoid mesothelioma can easily be confused with a chest-wall sarcoma. Despite lacking ultrastructural evidence of "epithelial" differentiation, immunocytochemical studies demonstrate cytokeratin. This distinguishes the sarcomatoid mesothelioma from most soft-tissue sarcomas. There remains a small number of cases, particularly those in the "poorly differentiated" or "transitional" category, in which the distinction between mesothelioma and metastatic carcinoma remains difficult. In this situation, it is imperative that all the clinical information be closely reviewed and a diligent search for a primary site be carried out. There are many parallels between reactive and neoplastic serosal tissue. The desmoplastic/sarcomatoid mesothelioma morphologically and immunocytochemically resembles the reactive multipotential subserosal cell (MSC) of injured serosal tissue, whereas the adenomatoid tumor, cystic peritoneal mesothelioma, and epithelial mesothelioma resemble surface mesothelium. The poorly differentiated mesothelioma resembles a stage of maturation between the two extremes, and thus the term "transitional" mesothelioma is suggested. The localized fibrous tumor of the pleura is unique among all other serosal neoplasms in its failure to express cytokeratin. It more closely resembles the unspecialized connective tissue fibroblast of normal serosal tissue, and thus may be more analogous to a soft-tissue tumor than to the remaining mesothelial-derived neoplasms.     

CT影像学诊断模型对鉴别腹膜疾病的临床价值

目的 利用Bayes判别分析建立诊断恶性腹膜间皮瘤、腹膜转移癌、结核性腹膜炎的CT影像学综合诊断模型,探讨其对腹膜疾病的鉴别诊断价值。方法 回顾性分析147例腹膜增厚患者的CT图像,收集胸膜、腹膜病变图像,组间卡方检验筛选出可以入组的变量。然后将147例患者随机分为试验组117例(79.6%)、检验组30例(20.4%),应用Bayes判别分析建立综合诊断模型。结果 通过3种腹膜疾病CT影像学表现组间比较,最终入组的变量为:腹膜增厚、大网膜增厚、肠壁固定、脏器受累(脏器浸润或转移)、胸膜斑。通过Bayes判别分析计算获得的三种腹膜疾病的CT影像学诊断模型。综合诊断模型的诊断准确率为89.7%,误判率为10.3%,检验组诊断准确率为86.7%,误判率13.3%,其中胸膜斑对恶性腹膜间皮瘤的诊断贡献度最大,为20.4。结论 CT影像学诊断模型对腹膜疾病鉴别诊断具有一定的临床价值。     

Diagnosis and therapy of malignant peritoneal mesothelioma

Malignant peritoneal mesothelioma is an uncommon tumor with great diagnostic and therapeutic problems. Symptoms, clinical features and course of the disease are described in three patients which were seen at our hospital within the last years. At the beginning there are often severe weight loss, malaise and sometimes fever of unknown origin. Abdominal pain, increased abdominal girth or nausea indicate advanced tumor stages in most cases. Ultrasonography and computed tomography of the abdomen can give important information during the diagnostic approach. Nevertheless, the definite diagnosis can only be established by laparoscopy or open surgery with biopsy for a histological examination. Despite intern and extern radiotherapy as well as systemic and/or local chemotherapy the prognosis of malignant peritoneal mesothelioma remains unfavourable. Mean survival time ranges from six to 18 months.     

Peritoneal mesothelioma

The definitive diagnosis of peritoneal mesothelioma and its differentiation from metastatic peritoneal carcinomatosis may be difficult because of the clinical, macroscopic, and microscopic variability of the tumor. To this purpose, a combination of criteria, including the clinical picture, the gross pathologic findings, the exclusion of other primary neoplasms, and the microscopic findings, must be taken into consideration. Conventionally, these criteria may be established only after surgical exploration and extensive sampling. Our experience with patients with peritoneal mesothelioma and metastatic peritoneal carcinomatosis, as well as a review of the recent imaging literature, shows excellent correlation between computed tomography or ultrasound and the operative or autopsy findings. These imaging modalities showed soft-tissue masses or nodules; thickened omentum ("omental cake"), peritoneum, mesentery, and bowel wall; pleural plaques; and usually disproportionally small, if any, ascites. The latter two observations may be useful in differentiating mesothelioma from carcinomatosis macroscopically. Furthermore, fine-needle aspiration biopsy, after performing wide sampling of the tumors in different locations under ultrasonic or computed tomographic guidance, produced diagnostic cytologic specimens. Thus, the need for exploratory surgery may be alleviated, and the diagnosis of peritoneal mesothelioma may be made prospectively and relatively noninvasively with the use of computed tomography or ultrasound and fine-needle aspiration biopsy. Since epidemiologic studies predict increasing incidence of this neoplasm, especially among asbestos workers, it is suggested that these techniques be seriously considered as screening methods for high-risk populations.     

内科胸腔镜在不明原因胸腔积液中的诊断价值

[目的]探讨内科胸腔镜对于不明原因胸腔积液病因的诊断价值.[方法]对经内科胸腔镜诊断的20例不明原因胸腔积液患者的临床资料进行分析、总结,通过与临床常用的鉴别良恶性胸腔积液的影像学、生化指标、胸腔积液细胞学检查等比较,评估内科胸腔镜检查的优势.[结果]20例患者中经胸腔镜直视下多部位取材病理活检的确诊率为85%(17/20):恶性间皮瘤5例,胸膜转移瘤5例,结核性胸膜炎6例,非特异性炎症1例;内科胸腔镜对恶性胸腔积液的敏感性为90.9%(10/11),特异性为100%(10/10).胸部CT显示胸膜厚度>1 cm,胸腔积液CEA/血清CEA>1检测的敏感性、特异性分别为45.6%(5/11)、100%(5/5)和80%(4/5)、75%(3/4),两者敏感性均低于内科胸腔镜( P <0.01);内科胸腔镜的常见并发症为活检部位出血、疼痛及发热.[结论]使用内科胸腔镜对胸腔积液的病因诊断具有较高的临床实用价值,为一种安全、有效、诊断率高的检查方法.     

超声引导下经皮肺和胸膜穿刺活检的应用

目的探讨超声引导下经皮肺、胸膜穿刺活检的组织学诊断准确性和并发症。方法对120例外周型肺占位和胸膜病变进行超声引导下的穿刺活检。结果120例患者均成功取材。病理结果示腺癌34例,鳞癌40例,低分化癌14例,小细胞癌4例,恶性间皮瘤4例,间皮瘤6例,结核病变4例,炎性病变12例,隔离肺2例。其中3例假阴性,活检结果为炎性病变,手术后病理结果示鳞癌。气胸7例,未经治疗自愈,咯血1例,其它112例均未出现明显并发症。结论超声引导下对外周肺、胸膜病变活检,具有准确性高、并发症少的特点,对临床诊疗具有重要的价值。