腹腔镜探查直视下诊断结核性腹膜炎价值探讨

目的 探讨腹腔镜探查直视下诊断结核性腹膜炎的价值.方法 我院自2005年1月至2008年12月对收治的65例怀疑结核性腹膜炎患者行腹腔镜探查活检术.34例患者确诊为结核性腹膜炎.将65例患者腹腔镜探查直视下诊断结果与病检结果进行比较.结果 腹腔镜直视诊断结核性腹膜炎敏感度88.24%,特异度90.32%.Youden指数=0.7856.结论 腹腔镜直视下诊断结核性腹膜炎确诊率高,安全可行.     

结核性腹膜炎腹腔镜探查直视下诊断价值研究

目的探讨腹腔镜腹腔探查直视下诊断结核性腹膜炎的价值和意义。方法对新疆维吾尔自治区人民医院自2005年1月至2009年12月收治的65例怀疑结核性腹膜炎患者行全麻腹腔镜腹腔探查活检术。其中34例患者确诊为结核性腹膜炎。将本组患者腹腔镜探查直视下诊断结果与病检结果进行比较。结果本组手术均成功,腹腔镜直视诊断结核性腹膜炎敏感度88.2%,特异度90.3%。Youden指数(YI)=0.78。结论腹腔镜直视下诊断结核性腹膜炎确诊率高,安全可行。结合病理检查可做为金标准。     

腹腔镜技术诊断结核性腹膜炎的应用价值

目的:探讨腹腔镜技术诊断结核性腹膜炎有效性及安全性.方法:回顾分析2006年1月至2011年1月为36例疑为结核性腹膜炎的患者行腹腔镜探查术的临床资料,并收集临床数据、腹水成分、组织病理活检进行临床评估.结果:32例患者经组织学活检及抗酸杆菌培养确诊为结核性腹膜炎,其中19例以腹腔粘连为临床表现,13例表现为腹水,腹腔镜确诊率为88 9％.术后无并发症发生,均经规范抗结核治疗治愈.结论:腹腔镜探查术是诊断结核性腹膜炎安全、准确的方法.     

腹腔探查对结核性腹膜炎诊断价值的临床观察研究

目的:探究腹腔探查对结核性腹膜炎诊断价值的研究,为临床提供指导。方法:以2010年1月1日—2018年4月30日我院37例疑似结核性腹膜炎患者作为观察对象,对37例疑似结核性腹膜炎患者均实施术前CT检查,其中13例行腹腔镜探查,24例行开腹探查,将CT检查结果、腹腔探查结果和术后病理活检结果进行比较,研究对比腹腔探查对结核性腹膜炎的诊断结果。结果:36例腹腔探查取腹膜活检病理回报证实为结核性腹膜炎,其中1例未确证结核性腹膜炎。腹腔探查诊断结核性腹膜炎的敏感度、特异度、总准确率分别为90%、100.00%、97.30%,CT诊断结核性腹膜炎的敏感度、特异度、总准确率分别为60.00%、50.00%、56.76%,腹腔探查诊断结核性腹膜炎的总准确率相比CT明显更高,P0.05;腹腔探查可有效对结核性腹膜炎进行分型诊断,总符合率为90.00%,将腹腔探查结果和术后病理活检结果进行对比发现,P0.05。结论:对结核性腹膜炎患者采取腹腔探查切实可行,具有较高的准确率,可为临床医师分析病情提供依据。     

腹腔镜探查对不明原因腹水的诊断价值

目的探讨应用腹腔镜探查不明原因腹水的诊断价值。方法对27例不明原因腹水患者进行腹腔镜探查及腹膜活检术。结果本组患者均成功行腹腔镜探查及腹膜活检术,病理证实结核性腹膜炎24例,腹膜间皮瘤1例,腹腔肿瘤2例。结论腹腔镜检查安全、确诊率高,对不明原因腹水有较高的诊断价值。     

腹腔镜腹腔探查用于诊断不明原因腹水的临床研究

目的:探讨腹腔镜探查用于诊断不明原因腹水的价值。方法:回顾分析1993年3月至2009年12月为102例不明原因腹水患者行腹腔镜腹腔探查活检术的临床资料。结果:97例经腹腔镜腹腔探查活检术明确病因,其中结核性腹膜炎41例(40.2%)。发生肠管损伤2例,切口二期缝合1例,术后一过性发热7例。不同常规影像学检查诊断符合率差异无统计学意义(P0.05)。常规检查费用之和较腹腔镜探查费用多(P0.05),花费时间之和明显长于腹腔镜检查(P0.01)。发病入院时结核性腹膜炎与腹腔内广泛转移癌患者血清糖类抗原125(carbohydrate antigen 125,CA125)值差异无统计学意义(P0.05);结核性腹膜炎患者入院时血清CA125值与正规抗痨治疗3个月后相比差异有统计学意义(P0.01)。结论:腹腔镜探查诊断不明原因腹水效率高,安全可行,经济,省时。血清肿瘤标记物CA125值的变化可作为评判结核性腹膜炎治疗效果的一种指标。     

腹腔镜探查在不明原因腹水诊断中的应用

目的:探讨腹腔镜探查在不明原因腹水诊断中的应用价值。方法:回顾性分析63例不明原因腹水患者行腹腔镜探查术,并取可疑组织送病理检查的临床资料。结果:腹腔镜探查明确诊断61例,其中结核性腹膜炎31例,转移性腺癌20例,腹膜间质瘤8例,淋巴瘤2例,均未发生并发症。结论:腹腔镜探查对于不明原因腹水的诊断安全有效,确诊率高,值得临床推广。     

不明原因腹水的腹腔镜探查(附32例报告)

目的:探讨腹腔镜用于探查不明原因腹水的价值。方法:回顾分析1999年6月至2009年6月我院为32例不明原因腹水患者行腹腔镜探查术的临床资料。结果:31例(96.9%)明确了腹水原因,其中肿瘤性腹水17例,结核性腹水12例,出血坏死性肠炎1例,盆腔炎1例;1例未查明病因。结论:不明原因腹水患者病因以恶性肿瘤及结核性腹膜炎为主;腹腔镜探查对诊断腹水病因有较高的实用价值。     

腹腔镜技术在结核性腹膜炎诊断中的应用

目的:探讨腹腔镜技术用于诊断结核性腹膜炎的价值,总结结核性腹膜炎的镜下特点及诊断要点。方法:回顾分析2002年7月至2010年7月27例结核性腹膜炎患者的临床资料。患者均行腹腔镜检查,术中取腹水及病灶标本行生化、病理学等检查。结果:27例患者均获确诊,手术时间30～140 min,平均40.2 min,术中出血量10～110 ml,平均12.3 ml。术中及术后均未出现肝、肠管等器官损伤。结论:腹腔镜检查诊断结核性腹膜炎具有患者创伤小、阳性率高、痛苦小等优点,可作为诊断结核性腹膜炎的优选术式。     

腹腔镜探查对不明原因腹水的诊断价值

目的评估腹腔镜探查对不明原因腹水的诊断价值。方法回顾性分析1998年3月至2009年10月间接受腹腔镜探查术的64例不明原因腹水患者的临床资料。结果本组有62例（96.9％）患者经腹腔镜探查活检明确诊断，其中结核性腹膜炎及肠结核26例，转移性腺癌20例，恶性淋巴瘤3例，淋巴细胞性白血病1例，淋巴窦组织细胞增生2例，间皮细胞瘤4例，嗜酸性细胞增多症1例，     

Laparoscopy in suspected abdominal tuberculosis is useful as an early diagnostic method

Background: Establishing a histological diagnosis in abdominal tuberculosis can be difficult, frequently delaying treatment. The aim of the study was to evaluate the role of laparoscopy for ascertaining the diagnosis in suspected abdominal tuberculosis. Methods: A retrospective review was undertaken of patients who underwent diagnostic laparoscopy for suspected abdominal tuberculosis over a 6‐year period, analysing its usefulness in establishing a histological diagnosis. Results: From May 1999 to April 2005, 131 patients underwent diagnostic laparoscopies in our institution, of which 41 patients had unknown aetiologies for ascites or abdominal pain. This subset of patients had been investigated for suspected abdominal tuberculosis with biochemical tests of serum and ascitic fluid; ultrasound and computed tomography scanning, upper and lower gastrointestinal endoscopies and contrast series, before being considered for diagnostic laparoscopy. None had manifest extra‐abdominal tuberculosis. At laparoscopy, 39 of these patients (95%) had peritoneal nodules. Frozen‐section biopsy from the peritoneal nodules established the diagnosis of tuberculosis in 33 patients (80%) whereas metastatic adenocarcinoma was reported in 6 (14%). Permanent sections confirmed the diagnosis of tuberculosis in all 33 patients. Only 2 (5%) patients had no findings on laparoscopy; nevertheless, on continuing follow up, no sinister diagnoses were made for these patients. Conclusion: In patients suspected to have abdominal tuberculosis without evidence of extra‐abdominal disease, early laparoscopy may be useful to establish a histological diagnosis with acceptably low morbidity (8%). Frozen section is useful to assess adequacy of biopsy and sampling. An extensive work‐up may hence be averted by a timely laparoscopy and early treatment can be instituted.     

Routine use of laparoscopy in patients with clinically doubtful diagnosis of appendicitis

BACKGROUND: Therapeutic and diagnostic laparoscopy, a minimal invasive technique, has been used effectively and frequently for appendicitis by surgeons. There is still controversy about whether this technique should be applied to all patients or in the setting of a doubt of the diagnosis of appendicitis, especially for women. Based on these controversies, the aim of this study was to assess the safety and efficacy of diagnostic and therapeutic laparoscopy for patients with suspected peritonitis imitating acute appendicitis. PATIENTS AND METHODS: Between May 2002 and September 2006, a consecutive series of 74 patients operated on for suspected acute lower quadrant peritonitis were studied retrospectively. Despite being unclear, the preoperative diagnoses were thought to be suspected peritonitis imitating acute appendicitis. Therefore, patients all had diagnostic and therapeutic laparoscopy. RESULTS: Seventy-four patients included in this study were successfully operated on by laparoscopy. Thirty-five of these patients were diagnosed with appendicitis and had an appendectomy by laparoscopy. Six of the 35 patients were converted to a conventional open appendectomy because of retrocecal localization and perforated appendicitis. In the 29 of the remaining 39 patients, pelvic inflammatory disease, mesenteric lenfadenopathy, torsed omentum and ruptured hemorrhagic, and endometrial or simple ovarian cysts were revealed. So, these 29 patients' (39.1%) appendices were left in place, and an unnecessary appendectomy was avoided, thereby reducing the negative appendectomy rate. In the remaining 10 patients, nothing was found to explain the clinical signs. After a mean follow-up period of 16 months, postoperative evaluations of the patients were satisfactory. CONCLUSION: Laparoscopy, a single procedure and an accurate modality for the diagnosis and treatment of patients with acute abdominal conditions, can be recommended in patients, especially fertile women, with suspected peritonitis imitating acute appendicitis when the diagnosis cannot be made by physical examination and noninvasive methods.     

The role of laparoscopy in patients with suspected peritonitis: experience of a single institution

PURPOSE: In this report, we retrospectively evaluate the effect of a laparoscopic approach in the diagnosis and treatment of acute abdominal pain in patients with suspected peritonitis. PATIENTS AND METHODS: We evaluated the clinical records of patients admitted to our institution between January 1995 and July 2001 with a diagnosis of acute abdomen and suspected peritonitis. RESULTS: Ninety four of 229 patients underwent diagnostic laparoscopy. In this series, 83 (88.3%) of the cases were successfully treated by emergent laparoscopy for an acute abdomen. Eleven (11.7%) required conversion to an open laparotomy procedure. Overall, the preoperative diagnosis was confirmed by laparoscopy in 67 (71.27%) of the cases. It was not confirmed in 27 (28.73%). Postoperative mortality was 4.25%. Morbidity was 8.5%. DISCUSSION: Data reported in the literature establish that laparoscopy offers adequate visualization of the entire abdomen and pelvic cavity in the diagnosis of an abdomen acute secondary to peritonitis. In this series, laparoscopy confirmed the diagnosis in 97.8% of the patients, and minimally invasive treatment was achieved in 88.3% of the cases. Female patients with gynecologic disease particularly benefitted from a laparoscopic approach, which permitted the correct evaluation of this condition and may have prevented unnecessary laparotomy. We believe that laparoscopy is an accurate modality for the diagnosis and treatment of patients with an acute abdomen and suspected peritonitis when the diagnosis cannot be clearly made by physical examination and noninvasive methods.     

A prospective audit of the use of diagnostic laparoscopy to establish the diagnosis of abdominal tuberculosis

Background

The incidence of abdominal tuberculosis is much higher in an HIV-positive cohort. The use of laparoscopy in the diagnostic work-up of suspected abdominal tuberculosis is underutilized and its use and efficacy in the context of HIV co-infection has never been examined.

Methods

A prospective clinical audit of the use of diagnostic laparoscopy was conducted in patients with clinically suspected abdominal tuberculosis but histologically or microbiologically unconfirmed tuberculosis at any site.

Results

From January 2008 to June 2010, 81 patients underwent diagnostic laparoscopy; 34 were male and 47 were female, with a mean age of 33 years, and 77 % were HIV-positive. Fifty-five patients (68 %) had positive histology or culture for tuberculosis. In 15 patients (19 %), histology revealed non-specific inflammation, no pathology was found in one patient, and no specimen was taken from one patient. Eighty percent of peritoneal deposits and 77 % of lymph nodes were positive for tuberculosis, whereas 35 % of ascitic fluid cultures were positive. In nine patients (11 %) an alternative diagnosis was found; nine patients (11 %) had conversion to laparotomy. There was no procedure-related death. Nine patients (11 %) died during the 2-month follow-up period.

Conclusions

Diagnostic laparoscopy avoids the morbidity and mortality of laparotomy in chronically ill patients, and reduces the rate of misdiagnosis of other abdominal conditions and unnecessary long-term therapy. Diagnostic laparoscopy and tissue sampling is a viable and reliable strategy in patients with suspected abdominal tuberculosis.     

Laparoscopy in intra-abdominal infection. Its diagnostic value and therapeutic possibilities

In 550 patients with the clinical features of acute abdomen a surgical laparoscopy was performed. In 121 cases there was found an unspecific reason of the acute abdominal disease that did not require surgical therapy. In 349 cases a regional peritonitis was found, 80 times a diffuse peritonitis. The diagnostic validity of laparoscopy was 96% as compared to 42% for sonography. The laparoscopic access resulted in a complication rate of 0.2%. In 239 cases (43%) the disease could be managed laparoscopically, 190 cases (35%) required open surgery.     

Pneumoperitoneum without perforation of the gastrointestinal tract

Pneumoperitoneum (PP) is usually the result of perforation of the gastrointestinal (GI) tract with associated peritonitis. However, other rare causes, including spontaneous PP incidental to intrathoracic, intra-abdominal, gynecologic, and miscellaneous other origins not associated with a perforated GI tract have been described in the literature. Six cases of PP without any perforated GI tract are reported. Three patients with generalized peritonitis underwent exploratory laparotomy or laparoscopy when clinical examinations suggested an acute abdomen. At surgical procedure, perforated pyometra, perforated liver abscess and a ruptured necrotic lesion of a liver metastasis were documented in these patients, respectively. We also saw 3 PP patients not associated with peritonitis. Two patients with PP caused by pneumatosis cystoides intestinalis were encountered, 1 was managed conservatively and the other received diagnostic laparoscopy. A patient in whom pneumomediastinum and pneumoretroperitoneum were accompanied by PP caused by an alveolar rupture based on decreased pulmonary compliance due to malnutrition was managed conservatively. The history of the patient and knowledge of the less frequent causes of PP can possibly contribute towards refraining from exploratory laparotomy in the absence of peritonitis.     

Diagnosis and treatment of pancreatic peritonitis]

Results of diagnosis and treatment of 71 patients with general pancreatogenic peritonitis (7.3% of all patients with general peritonitis) are analyzed. The main diagnostic methods were ultrasound (100% cases), computed tomography (29.5%), laparoscopy (60%). Based on clinical, instrumental, bacteriologic and morphologic examinations primary and secondary pancreatogenic peritonitis are distinguished. Optimal policy of treatment depended on peritonitis forms. In primary (enzyme peritonitis) minimally invasive methods of treatment were used: laparoscopic drainage of abdominal cavity and bursa omentalis, therapeutic blockades etc. in secondary (bacterial) peritonitis wide laparotomy with sanations of abdominal cavity and minor bursa omentalis were used. Consecutive necrectomies and sequestrectomies were preferred (70.2%). Advantages of hemofiltration over other methods of efferent therapy are demonstrated. The above methods of treatment permitted to decrease postoperative lethality in secondary purulent pancreatogenic peritonitis from 68 to 44%.