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目的 探讨腹腔镜对女性不明原因腹水的诊断价值. 方法 2001年6月~2005年6月在全麻或局麻下对23例女性不明原因腹水进行腹腔镜探查,取可疑组织送病理检查.结果 腹腔镜探查阳性20例,阳性率87.0%(20/23),其中结核性腹膜炎9例,转移性腺癌4例(胃癌2例,结肠癌1例,胰腺癌1例),卵巢恶性肿瘤3例(卵巢浆液性上皮癌2例,卵巢黏液性上皮癌1例),卵巢外腹膜浆液性乳头状癌2例,腹膜间皮瘤1例,肝硬化1例;不明原因3例.腹腔镜肉眼诊断与病理检查诊断的符合率为65.0%(13/20).结论 腹腔镜探查腹水病因是一种安全有效的方法,通过镜下观察及活检可以确定产生腹水的原因. 相似文献
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目的探讨腹腔镜探查对不明原因腹水的诊断价值。方法 2007年11月~2010年11月46例不明原因腹水局麻下行腹腔镜探查术。1%利多卡因5 ml局麻,选择脐部或需要穿刺的部位作为穿刺点,做10 mm或5 mm切口,建立CO2气腹(压力<8 mm Hg),置入腹腔镜,根据镜下所见做切口置入5 mm trocar,根据腹水量和操作需要缓慢放腹水500~2000 ml,然后腹腔探查,取材。结果 1例因腹腔内粘连严重腹腔镜探查未成功。活检阳性43例,阳性率95.6%(43/45),其中结核性腹膜炎37例(86.0%,37/43),转移性腺癌3例(7.0%,3/43),腹膜间皮瘤1例(2.3%,1/43),卵巢外腹膜浆液性乳头状癌1例(2.3%,1/43),淋巴瘤1例(2.3%,1/43);未明确诊断3例,阴性率(3/46,6.5%)。所有病人均未发生并发症。结论不明原因腹水患者病因以结核性腹膜炎及恶性肿瘤为主,局麻下腹腔镜检查对不明原因腹水诊断安全有效。 相似文献
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目的:探讨腹腔镜技术诊治不明原因腹水的应用价值。方法:回顾分析2005年1月至2010年12月为35例不明原因腹水患者行腹腔镜探查活检术的临床资料。结果:35例手术均顺利完成,无手术并发症发生。中位手术时间23 min,平均出血10 ml。经病理、免疫组化检查,确诊34例(确诊率97.1%)。结核性腹膜炎20例(57.1%);腹腔恶性肿瘤12例(34.3%),其中腹膜间皮瘤4例,转移性腺癌4例,卵巢癌2例,淋巴瘤2例;其他3例(8.6%),其中肝硬化2例,未确诊1例。结论:对于不明原因腹水的病因诊断,腹腔镜探查术具有安全、高效、创伤小、确诊率高等优点,应果断行腹腔镜探查术,但腹腔镜探查术并不能代替常规检查。 相似文献
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诊断性腹腔镜的临床应用 总被引:1,自引:0,他引:1
目的:探讨诊断性腹腔镜的临床应用价值。方法:2001年9月至2008年7月为70例有临床症状,但诊断不明确的患者进行了腹腔镜探查。可疑组织送病理检查。结果:腹腔镜手术探查阳性61例,阳性率87.1%。其中不明原因腹水52例,46例确诊(88.5%);慢性腹痛4例,3例确诊(75%);腹腔肿块4例,3例确诊(75%);肠梗阻3例和急腹症5例,均得到确诊(100%);其他2例,明确诊断1例。结论:腹腔镜探查是一种安全有效的诊断方法,通过镜下观察及活检组织的病理检查基本可以明确病因。 相似文献
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《临床外科杂志》2016,(6)
目的总结双孔法腹腔镜手术在小儿不明原因下消化道出血诊治中的应用体会。方法小儿不明原因下消化道出血54例,采用双孔法腹腔镜行诊断与治疗。结果腹部超声组检查确诊率15.09%(8/53),腹部CT检查组确诊率11.54%(3/26),放射性核素组检查确诊率76.47%(39/51),腹腔镜探查组确诊率98.15%(53/54),53例发现小肠畸形,1例未发现异常。腹腔镜组探查确诊率高于其他3组。53例行腹腔镜手术均获得成功,无中转开腹手术;手术时间56~75分钟,平均67分钟,出血量3~10 ml。术后病理检查证实为美克尔憩室45例、小肠重复畸形7例、小肠血管畸形1例。结论双孔法腹腔镜手术用于小儿不明原因下消化道出血疾病具有诊断及治疗的双重价值,降低了腹腔镜手术的难度,适用于婴儿期甚至新生儿期患儿。 相似文献
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腹腔镜在鉴别诊断女性盆腔结核和卵巢癌中的价值 总被引:3,自引:0,他引:3
童兴海 《中国微创外科杂志》2008,8(3):210-211
目的探讨腹腔镜技术在鉴别诊断女性盆腔结核和卵巢癌中的价值。方法1997年3月~2003年12月,对我院50例腹水及盆腔包块入院不能明确诊断的病人行腹腔镜检查,在直视下取可疑组织送病理检查。结果术中诊断15例盆腔结核,25例卵巢癌,10例原因不明。结论以不明原因腹水及盆腔包块为临床症状的盆腔结核患者可借助腹腔镜检查及镜下广泛取材明确诊断,避免不必要的剖腹探查。腹腔镜技术在鉴别诊断女性盆腔结核与卵巢癌中有明确、肯定的价值。 相似文献
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腹腔镜腹腔探查用于诊断不明原因腹水的临床研究 总被引:2,自引:1,他引:1
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。 相似文献
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A novel approach: transumbilical endoscopic exploration and biopsy for patients with unknown ascites
Y Yang W Zhang H Xu H Lv Z Ma D Xue 《Journal of laparoendoscopic & advanced surgical techniques. Part A》2012,22(7):691-694
Abstract Background: The main surgical methods used for the diagnosis of unknown ascites are laparotomy, laparoscopic exploration, and natural orifice translumenal endoscopic surgery (NOTES). This article introduces a novel method: transumbilical endoscopic exploration and biopsy. Patients and Methods: From September 2009 to January 2012, 11 patients with unknown ascites were scheduled for transumbilical endoscopic exploration and biopsy at the First Affiliated Hospital of Harbin Medical University, Harbin, China. After the patient underwent general anesthesia and artificial pneumoperitoneum, a 1.0-cm trocar was placed at the umbilical region. After initial observation of the whole peritoneal cavity with a laparoscope, a sterile endoscope (gastroscope) was put through the trocar. The surgeon regulated the depth of insertion of the endoscope and the direction of the trocar, while the endoscopic physician was in charge of turning the camera lens of the endoscope, controlling the biopsy forceps, irrigation, and suction. After exploration, four to six pieces of tissues were obtained for biopsy. Results: These patients were diagnosed by endoscopic exploration and pathological examination: 3 cases were tuberculous peritonitis, 2 cases were malignant peritoneal mesotheliomas, 2 cases were peritoneal carcinomatosis, 1 case was a small intestinal tumor, 2 cases were advanced ovarian cancer, and 1 case was cirrhosis. Conclusion: Transumbilical endoscopic exploration and biopsy is an easy, practical, and effective method for the diagnosis of unknown ascites. 相似文献
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目的 探讨卵巢外腹膜癌患者的临床误诊原因.方法 回顾性分析19例卵巢外腹膜癌的临床表现、血肿瘤标志物、影像学特征、手术探查、病理学检查结果 、治疗和预后.结果 卵巢外腹膜癌最常见的临床表现为腹胀、腹痛和腹围增大.19例患者中,测定血中糖类抗原125(CA-125)者17例,15例升高,其中4例腹水中测得CA-125明显升高(>104KU/L),12例腹水中找到癌细胞.19例患者中,有3例误诊为子宫来源肿瘤,13例误诊为附件肿瘤,1例误诊为膀胱、肠道来源肿瘤,其中仅有2例术前即诊断为腹膜肿瘤,误诊率89.47%(17/19).术后病理结果 得以证实为腹膜恶性肿瘤,5年生存率仅20%.结论 无明显诱因的腹胀腹痛是本病的主要临床表现,仔细的体格检查有时可以提供重要信息,异常增高的血CA-125水平及腹水穿刺结果 有助于卵巢外腹膜癌的诊断和鉴别诊断,CT对腹膜原发灶具有诊断价值.Abstract: Objective To analyze the misdiagnosis in extraovarian peritoneal carcinoma(EOPC). Methods The clinical manifestation, blood tumor marker, imaging examination, laparotomy, pathology, treatment and prognosis of 19 EOPC patients were retrospectively analyzed. Results The clinical symptoms were abdominal distention, abdominal pain and swelling. 17 cases were tested for blood CA-125 with 15 at abnormaly high level, and in 4 cases ascites was CA-125 positive ( > 10 KU/L). Tumor cells were detected in the ascites in 12 cases. Three cases were misdiagnosed as of uterine origin, 13 cases misdiagnosed as adnexal tumor, 1 case was misdiagnosed as bladder and intestinal tumor. Only 2 cases were correctly diagnosed before the operation. All of the cases were pathologically proved as peritoneal carcinoma. The five-year survival rate was only 20 percent. Conclusions Abdominal distention and pain with unknown causes were the primary manifestations of EOPC, elaborate physical examination sometimes may provide with important information. The significant elevation of serum CA-125 and the ascites cytology may be helpul for the differential diagnosis of PPC. CT scan is valuable for the diagnosis of EOPC. 相似文献
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BACKGROUND: Systemic inflammatory response syndrome (SIRS) and sepsis of unknown origin are common complications of critically ill patients in the ICU. These patients frequently have unreliable clinical exams and are candidates for exploratory laparotomy. Although abdominal CT is commonly used because it is less invasive than laparotomy, it is often unreliable or unobtainable. Bedside laparoscopy is an alternative technique that may be more accurate than CT in selected patients and less invasive than laparotomy. METHODS: We performed diagnostic laparoscopy (DL) in a series of ICU patients with SIRS/septic state of unknown origin between May 1997 and June 1998. All patients were unstable and required significant respiratory and hemodynamic support. Laparoscopy was either performed in the ICU at the patient's bedside or in the operating room. CT scan of the abdomen had been performed on most of the patients who were stable enough to transport. Confirmation of diagnosis was obtained either by laparotomy, autopsy, or clinical recovery. RESULTS: Among the 17 eligible patients, 16 underwent successful DL. Insufflation was impossible in one patient because of high intraabdominal pressure. Bedside evaluations were performed in 14 of the 17 patients. There were no complications from the laparoscopy. Six patients were identified as positive (four intestinal ischemia, two cholecystitis); the other 10 had negative explorations. Follow-up on two patients with negative laparoscopy was incomplete due to denied postmortem. Laparoscopic diagnoses were confirmed in the remaining 14 patients by laparotomy (six cases), postmortem (three cases), or recovery (five cases), with an accuracy of 100%. The overall accuracy of abdominal CT obtained in nine of the 14 patients was 33%. CONCLUSIONS: DL in a select group of critical ICU patients is safe and accurate, whereas CT scan tends to be inaccurate and is often unobtainable due to patient instability. Performing the procedure at the bedside can expedite the diagnosis, eliminate the burden for transfer, and save on anesthesia and operating room charges. 相似文献