腹腔镜诊断恶性腹膜间皮瘤

恶性腹膜间皮瘤(malignanl peritoneal mesothelioma,MPM)临床上比较少见,病情进展迅速,预后不良,临床表现无特异性,诊断较为困难,误诊率较高。现回顾分析我院1996年至2001年经腹腔镜检查并经病理证实的MPM 20例患者的临床表现及腹腔镜下特点,为MPM的诊断提供一种快速准确的方法。     

腹膜活检52例分析

对52例不明原因的腹水及腹块病人用Vim Silverman双分叶片状针经皮、腹腔镜直视下及腹部小切口开窗腹膜活检,诊断率分别为6.7％、93.3％和100％.其中结核性腹膜炎19例,腹膜转移癌16例,腹膜间皮瘤1例,16例未获得诊断。作者认为,腹腔镜直视下腹膜活检和腹部小切口开窗活检对腹内肿瘤性或结核性疾病的鉴别诊断有重要价值.并对其适应症、优缺点进行了讨论.     

腹腔镜在消化疾病诊断中的价值浅析

目的探讨腹腔镜检查在腹部疑难疾病诊断中的价值．方法临床诊断困难的腹水、腹部包块患者18例，应用45°斜视式腹腔镜进行检查，同时进行直视下活检，其中腹水13例，腹部包块5例，男11例，女7例，年龄19岁～62岁，检查结束后比较直视与病理诊断符合情况．结果18例患者均检查成功，其中17例明确诊断，确诊率94．4％，直视与病理检查符合率88．8％，诊断为结核6例、肝硬变5例、肝癌3例、恶性间皮瘤2例、结肠癌腹膜转移回例．无并发症发生，术后恢复快．结论腹腔镜检查准确、安全、损伤小、恢复快、经济，对腹部疑难病的诊断有独到之处，可替代不必要的剖腹探查，同时还可进行适当的治疗，因此有着极高的临床适用价值．     

腹膜疾病诊断42例

目的:对42例腹膜病变患者临床资料进行分析,以提高该类疾病的诊断水平.方法:42例腹膜病变患者,男22例,女20例,年龄17-89岁,平均54岁.对所有患者进行CT与血清肿瘤标志物检查、40例行腹穿术、9例行PET/C1检查、13例行超声引导下经皮腹膜活检术.分析腹膜病变的病因和各诊断方法的灵敏性、特异性和准确性.结果:血清CEA、CA153、CA19-9、CA242和CA125对腹膜恶性肿瘤诊断的灵敏性分别为14.8%、18.5%、29.6%、22.2%及100%,特异性分别为80.0%、93.3%、93.3%、93.3%及0%.腹水脱落细胞对腹膜恶性病变诊断的灵敏性为36%,特异性为100%;腹水ADA对腹膜结核性病变诊断的灵敏性为92.3%,特异性为92.5%.8例CT检查结果支持最后诊断,准确率为19%;7例PET/CT检查结果支持最后诊断,准确率为78%:11例腹膜活检术结果支持最后诊断,准确率为85%.结论:肿瘤标志物、腹水脱落细胞和ADA检查对腹膜炎性与肿瘤性病变的鉴别有一定的辅助意义.PET/CT和腹膜活检对腹膜病变诊断的准确性明显高于CT.     

诊断性腹腔镜的临床应用研究

目的：评价诊断性腹腔镜的检查方法、效果及安全性，提高腹部疑难疾病的早期诊断率。方法：回顾分析58例腹部疑难疾病患者的腹腔镜检查情况，其中腹水原因待查35例，腹水＋腹部包块23例。结果：58例患者中诊断为结核性腹膜炎31例，恶性腹膜间皮瘤23例，腹膜转移癌2例，盆腔结核及慢性盆腔炎各1例。不同疾病在腹腔镜下有不同表现。操作时间25－70min，平均38min。并发症为活检处出血4例，其中3例为自限性因，1例经局部喷洒凝血酶后停止，术后伤口漏水5例。对腹腔镜下有肯定判断的12例患者同时进行治疗。结论；腹腔镜检查具有安全、简便、微创、痛苦小、确诊率高等优点。诊断性腹腔镜值得进一步推广应用。     

经腹腔镜诊治恶性腹膜间皮瘤三例

经腹腔镜诊治恶性腹膜间皮瘤三例蔡恩齐王丽青赵立强温建廷１９９６年２月～６月，我院应用腹腔镜诊治恶性腹膜间皮瘤３例，报道如下。１．临床资料：男２例，女１例，年龄为４０、５４、５７岁，发病时均误诊为“结核性腹膜炎”，经抗结核、应用激素及反复抽腹水等治疗无...     

腹腔镜超声技术在胰腺癌诊断分期中的应用

随着腹腔镜技术的广泛开展，临床上越来越关注腹腔镜手术中因触觉丧失叉无法直视的腹腔内脏器深部及腹膜后间隙的病变及病灶与邻近器官之间的解剖关系等问题。腹腔镜超声（LUS）的问世使腹腔镜应用范围更加广泛，几乎涉足了开腹手术的各个领域。近年来，国内外学者开始利用LUS对胰腺癌进行诊断和分期，对肿瘤侵犯程度或淋巴结转移做出进一步评估，达到选择最适宜的手术方法的目的。     

腹腔镜与肝活检组织学检查诊断肝硬化的研究

腹腔镜检查诊断肝硬化是通过腹腔镜下观察到肝脏表面弥漫分布小结节和肝脏质地变硬 ,以及腹腔镜直视下取肝活检标本进行组织学检查来确定[1] 。然而由于肝硬化时肝脏病变是不均匀的 ,因此活检标本的误差常导致组织学检查的假阴性结果。我们分析了腹腔镜检查所见肝脏表面的特征性表现与腹腔镜直视下肝活检组织学检查对肝硬化诊断的准确性。一、对象与方法1.研究对象 :1997年 6月～ 2 0 0 1年 11月经临床确诊并在我科接受腹腔镜检查的肝硬化患者 32例 ,其中男 2 5例 ,女 7例 ,年龄 31～ 4 8岁。病因主要为 :乙型肝炎病毒感染 2 2例 (6 8.8% ) …     

腹膜活检对结核性腹膜炎的诊断价值

目的评价经皮腹腔穿刺腹膜活检对结核性腹膜炎的诊断价值。方法使用自动弹簧活检针对34例临床上考虑为结核性腹膜炎患者进行腹膜活检,并进行病理诊断。结果34例患者均经一次穿刺取出腹膜壁层组织,经病理证实结核性腹膜炎26例、转移性腺癌3例、恶性淋巴瘤1例和大致正常腹膜组织4例,一次穿刺活检成功率为100％,经活检明确腹水病因的诊断率为88．2％。结论腹膜活检对结核性腹膜炎诊断及鉴别诊断,有重要的临床诊断价值。     

可弯曲式内科胸腔镜在恶性胸膜间皮瘤中的诊断价值

目的探讨可弯曲式胸腔镜对恶性胸膜间皮瘤的诊断价值。方法对30例不明原因胸腔积液患者进行胸腔镜检查。全麻下于腋部胸壁第6～7肋间置入胸腔镜套管,吸去大部分胸腔积液后按照内、前、上、后、侧、下的顺序观察胸膜腔并进行胸膜活检。结果 30例患者中有6例经直视下取活检病理证实为恶性胸膜间皮瘤。结论胸膜间皮瘤,单纯依靠影像学诊断较为困难,通过内科胸腔镜可在直视下取到理想的胸膜组织,提高了诊断阳性率。     

Diagnostic value of fibrolaparoscopy and direct-vision peritoneal biopsy in atypical tuberculous peritonitis]

Fifty-three cases of atypical tuberculous peritonitis were diagnosed by Machida FLA-8 fibrolaparoscope and direct-vision peritoneal biopsy in our hospital during the last few years. The misdiagnosis rate of this disease is very high. The rate of accurate clinical diagnosis was only 39.6% in patients of this study, while 60.4% was misdiagnosed as other diseases, such as cirrhosis, chronic hepatitis, hepatic carcinoma ovarian cyst etc. In addition, many patients with other diseases were misdiagnosed as tuberculous peritonitis by clinical consideration, for instance, 56 cases who were diagnosed or doubted as tuberculous peritonitis by clinical consideration were diagnosed as other diseases by laparoscopy and liver and peritoneal biopsy under direct-vision. Among them chronic hepatitis accounted for 32 cases, peritoneal carcinoma 11 cases, cirrhosis 7 cases, normal peritoneum, liver, gall bladder and spleen 6 cases. Therefore, the patient who is presumptively diagnosed as tuberculous peritonitis by clinical consideration should have laparoscopy and direct-vision peritoneal biopsy performed.     

Laparoscopic diagnosis of peritoneal mesothelioma

Summary This is the second report of a malignant peritoneal mesothelioma diagnosed by laparoscopy and guided needle biopsy and the first with photographic documentation of the lesion. The case illustrates the following points: (1) diagnosis of peritoneal mesothelioma should be considered in the evaluation of exudative ascites; (2) the only definitive diagnostic procedure is to obtain tissue for histology; and (3) laparoscopy with biopsies under direct vision is an accurate and safe technique which is underutilized and should be considered as the diagnostic procedure of choice when peritoneal disease is suspected.     

Malignant peritoneal mesothelioma a clinical and laparoscopic study of ten cases

Summary A retrospective study of 10 cases of malignant peritoneal mesothelioma from two centers is reported. All cases were initially diagnosed between 1967 and 1986 utilizing laparoscopy and the histologic interpretation of laparoscopic biopsy samples. Subsequently, the original diagnosis was confirmed by two independent pathologists employing both histological and histochemical techniques. In five cases immunohistochemical studies were also performed. The clinical findings and course of the disease were similar to other reported series. Laparoscopic findings of mesothelioma were indistinguishible from metastatic peritoneal neoplasms. However, the presence of homogeneous spreading of nodules, plaques, or fleshy masses on both parietal and visceral peritoneum; the absence of direct or indirect signs of other abdominal neoplasms; and the absence of hepatic metastases or the possible presence of nodules or plaques on Glisson's capsule without any parenchymal involvement, when observed, allowed the laparoscopist to suspect the disease in four of 10 cases. Laparoscopy may be useful in detecting mesothelioma. The diagnosis is mainly morphological, but even morphology has its inherent limitations. Further studies are necessary to improve the diagnostic accuracy of this tumor.A part of this study was presented during the 12th International Congress of Gastroenterology and the 5th International Congress of Gastrointestinal Endoscopy in Lisbon, Portugal, September 16–22, 1984.     

CT薄层影像特征制定的肺结节分级评估系统区分良恶性肺结节的应用价值

目的探究CT薄层影像特征制定的肺结节分级评估系统区分孤立性肺结节(SPN)良恶性的应用价值。方法回顾性分析我院2018年9月至2020年7月确诊的122例SPN患者的临床资料。采用CT薄层影像特征制定的肺结节分级评估系统进行分级评定,并以病理诊断结果为“金标准”,分析其准确性、敏感度及特异度,并通过Kappa检验分析其与病理诊断结果的一致性。结果病理诊断证实良性SPN 56例,占45.9%(56/122),多为不典型增生及错构瘤,占28.6%(16/56),恶性SPN 66例,占54.1%(66/122),多为腺癌及鳞癌;肺结节分级标准分类2级31例、3级29例、4A级9例、4B级53例;肺恶性结节中,空泡征、宝石征、肿瘤血管征、毛刺征的发生率明显高于肺良性结节(均P<0.05),而病灶周围有卫星病灶的发生率明显低于肺良性结节(P<0.05);将肺结节分级标准中3级及以下归为阴性结节,4级及以上归为阳性结节,诊断准确率为90.2%。肺结节分级标准诊断肺良性结节与病理结果表现出了较好的一致性(Kappa=0.803),以肺结节分级标准诊断肺良性结节的结果与“金标准”(病理诊断结果)比较,得到的敏感度87.9%(58/66)和特异度92.9%(52/56)。结论影像诊断时,合理利用基于CT薄层影像特征制定的肺结节分级评估系统能有效地分类CT筛查出的肺结节,较好区分SPN的良、恶性。     

CT薄层影像特征制定的肺结节分级评估系统区分良恶性肺结节的应用价值

目的探究CT薄层影像特征制定的肺结节分级评估系统区分孤立性肺结节(SPN)良恶性的应用价值。方法回顾性分析我院2018年9月至2020年7月确诊的122例SPN患者的临床资料。采用CT薄层影像特征制定的肺结节分级评估系统进行分级评定,并以病理诊断结果为“金标准”,分析其准确性、敏感度及特异度,并通过Kappa检验分析其与病理诊断结果的一致性。结果病理诊断证实良性SPN 56例,占45.9%(56/122),多为不典型增生及错构瘤,占28.6%(16/56),恶性SPN 66例,占54.1%(66/122),多为腺癌及鳞癌;肺结节分级标准分类2级31例、3级29例、4A级9例、4B级53例;肺恶性结节中,空泡征、宝石征、肿瘤血管征、毛刺征的发生率明显高于肺良性结节(均P<0.05),而病灶周围有卫星病灶的发生率明显低于肺良性结节(P<0.05);将肺结节分级标准中3级及以下归为阴性结节,4级及以上归为阳性结节,诊断准确率为90.2%。肺结节分级标准诊断肺良性结节与病理结果表现出了较好的一致性(Kappa=0.803),以肺结节分级标准诊断肺良性结节的结果与“金标准”(病理诊断结果)比较,得到的敏感度87.9%(58/66)和特异度92.9%(52/56)。结论影像诊断时,合理利用基于CT薄层影像特征制定的肺结节分级评估系统能有效地分类CT筛查出的肺结节,较好区分SPN的良、恶性。     

Role of laparoscopy in the evaluation of patients with suspected hepatic or peritoneal malignancy.

The purpose of this study was to determine the role of laparoscopy in patients with suspected hepatic or peritoneal malignancy and a normal computerized tomograph (CT). Twenty-five consecutive patients with a normal liver and no peritoneal lesions on CT were evaluated. Patients with a documented primary neoplasm or a positive ascitic fluid cytology were excluded. At laparoscopy, malignancy was documented by biopsy in 12 patients for an incidence of 48%. Of the patients with exudative ascites, 75% had peritoneal metastases. In addition seven patients had benign liver disease documented by laparoscopic biopsy. Liver enzymes were not helpful in distinguishing benign and malignant disease in this group of patients. This study indicates that a negative CT does not exclude liver or peritoneal malignancy. Laparoscopy has a significant yield in patients with a negative CT suspected of having hepatic or peritoneal malignancy and is the procedure of choice in evaluating these patients.