双频超声诊断结核性腹膜炎的价值探讨

目的探讨结核性腹膜炎的声像图表现,以提高其超声诊断水平。方法用低频与高频超声联合诊断结核性腹膜炎患者126例。并经手术,大网膜穿刺活检,腹水穿刺检查,X-线胸片、腹部平片,子宫输卵管碘油造影及PPD试验等多项检查综合判断。结果126例结核性腹膜炎全部经临床抗痨治疗痊愈证实。超声检出腹膜壁层增厚115例(91.3%);腹水无回声区126例(100%),腹水无回声区间条状或网格状光带118例(93.7%);肠壁浆膜层增厚95例(75.4%);大网膜增厚103例(81.7%)。其中经手术病理证实8例;大网膜穿刺活检证实21例;85例腹水化验细胞数增高,以淋巴细胞为主,未见癌细胞;126例均行X-线胸片检查,检出肺结核48例;39例行X-线腹部平片检查,检出腹腔淋巴结钙化灶3例;16例行X-线子宫输卵管碘油造影,检出子宫输卵管结核9例;126例均行PPD试验,强阳性123例。结论低频与高频超声联合应用,能对结核性腹膜炎进行诊断与鉴别诊断,可作为诊断结核性腹膜炎的一种有效检查方法。

Low and High Frequency Ultrasound in Diagnosing Tuberculous Peritonitis

Objective The sonographic features of tuberculous peritonitis were explored so as to improve the diagnostic accuracy.Methods A total of 126 cases with tuberculosis peritonitis were diagnosed with low- and high-frequency ultrasound and proved comprehensively by pathology,omental biopsy,ascitic paracentesis,x-ray of the chest,abdominal,uterotubography,PPD test and so on.Results All 126 cases with tuberculosis peritonitis were cured and proved by clinical antituberculotic treatment.In 115 cases the detected rate of thickened abdominal peritoneum on ultrasonography,was 91.3% (115/126):In 126 cases with echo-lucent ascites had sonographic detection rate of 100%:among which 118 cases were with linear or netted bright lines,93.7% (118/126):Ninety-five cases with thickened intestinal serosa with diagnostic rate of 75.4% (95/126),103 cases had thickened omentitis,(103/126,81.7%),among which 8 cases were proved by pathology,21 cases by omentum biopsy and 85 cases by cells in ascites mainly lymphocytes,but without tumor cells.Fourty-eight cases with phthisis were verified by chest X-ray.In 39 cases,3 cases were detected with abdominal lymphadenic calcification by abdominal plain X-ray films.Sixteen cases underwent uterotubography of whom 9 cases were detected uterotubal tuberculosis.PPD test in 123 cases had strong positive reaction.Conclusions Tuberculous peritonitis can be diagnosed and differential diagnosed using low- and high-frequency ultrasound that may be the best selection for the diagnosis of tuberculous peritonitis.