疑难性腹部疾病诊断性腹腔镜下常见与罕见病变的特征

目的 探讨疑难性腹部疾病诊断性腹腔镜下常见与罕见病变的特征。方法 对31例临床难以诊断的腹痛、腹水和腹块患进行了电视腹腔镜检查以及窥视下多部位、多点和块状组织活检病理组织学检查。结果 ①31例腹腔镜检查均获成功，经活检病理组织学检查30例明确诊断，确诊率达96．77％（30／31）。其中良性病变17例（54．84％），恶性病变14例（45．16％），并发现罕见腹部疾病11例（35．48％）（肠系膜淋巴管囊性扩张1例，腹膜转移性透明细胞癌2例，腹腔恶性淋巴瘤3例，腹膜恶性间皮瘤3例，大网膜恶性间叶肿瘤1例和腹膜假粘液瘤1例）。②本组不同罕见病变各有其特征。结论 腹腔镜检查是疑难性腹部疾病（不明原因腹痛、腹水和腹块）病因诊断是一种确诊率高、安全、快速的方法，能及时发现罕见病；腹腔镜窥视下块状组织活检可显提高确诊率，在众多检查中，对疑难性腹部疾病诊断率最高。

Characteristics of diagnostic laparoscopy on rare and common pathological changes of complicated abdominal diseases

Objective To explore characteristics of diagnostic laparoscopy on rare and common pathological changes of the complicated abdominal diseases. Methods 31 complicated cases of abdominal pain,ascites and abdominal mass underwent video laparoscopy and multi－ piece biopsy from multi－ position. Results ① All cases underwent laparoscopy successfully and 96.77％ (30/31) cases(benignancy 17,malignancy 14)were diagnosed clearly by biopsy and histology diagnosis in which the 11(35.48％ )cases(mesenteric lymphangiectasia 1,metastatic peritoneal malignant transparent cytoma 2,malignant lymphoma 3,peritoneal mesothelioma 3,malignant omentum majus mesothelioma 1 and peritoneal pseudomyxoma 1)were rare.② Characteristic of various rare diseases was shown. Conclusion Diagnostic laparoscopy on complicated abdominal diseases(abdominal pain,ascites and abdominal mass of unknown origin)is a safe,rapid,sensitive and special method on the etiological diagnosis and can find the rare diseases timely.diagnostic rate of video laparoscopy on complicated abdominal diseases is the highest among varied examinations and could be improved significantly by multi－ piece biopsy from multi－ position.