腹腔镜对不明原因腹水诊断价值研究

目的探讨腹腔镜探查对不明原因腹水的诊断价值及总结手术操作经验。方法回顾性分析1999年9月至2006年10月,第二军医大学附属长海医院普外科在全麻下对72例不明原因腹水病人进行腹腔镜探查,并取可疑组织送病理检查的病例资料。结果腹腔镜手术探查阳性68例(阳性率94.5%),其中结核性腹膜炎44例(61.1%),转移性腺癌12例(占16.7%),腹膜间皮瘤5例(占7.0%),卵巢外腹膜浆液性乳头状癌4例(占5.5%),淋巴瘤、血吸虫病、结肠癌各1例,未明确诊断4例(阴性率为5.5%)。行腹腔镜探查术的病人均未出现并发症。结论腹腔镜腹水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确定产生腹水的病因。腹腔镜在不明原因腹水探查的应用,对操作有其特别要求。

Diagnostic laparoscopy in ascites of unknown origin

Objective To investigate the diagnostic value and surgical technique of laparoscopic exploration in patients with ascites of unknown origin.Methods Laparoscopic exploration under general anesthesia was performed in 72 patients with ascites of unknown origin between September 1999 to October 2006 in the Department of General Surgery of Changhai Hospital of Second Military Medical University.All the suspected tissues were taken for pathologic examination.Results Sixty-eight patients were positive by laparoscopy (94.5%).Among them,the major cause was tuberculous peritonitis (44/72,61.1%);metastatic adenocarcinoma ranked the second (12/72,16.7%);the third was peritoneal mesothelioma (5/72,7.0%);the forth was extraovarian peritomeal serous papillocarcinoma (4/72,5.5%);the rest three cases were lymphoma,schistosomiasis and colon carcinoma respectively.The origin of the other 4 cases remained unknown (5.5%).Due to preoperative preparation and careful operation,no complication was found in the series.Conclusions Laparoscopic exploration is safe and effective for the determination of origin of ascites.Laparoscopy and histopathological examination can reveal the causes for ascites.Special preoperative preparation and operational technique is required in performing diagnostic laparoscopy.