经自然腔道内镜手术腹腔内镜探查对腹膜恶性肿瘤的诊断价值

目的探讨经自然腔道内镜手术（NOTES）腹腔内镜探查对腹膜恶性肿瘤的诊断价值。方法回顾性分析腹膜恶性肿瘤患者NOTES腹腔内镜探查的内镜表现、肿瘤病理学诊断及肿瘤来源。结果53例腹膜恶性肿瘤患者中，腹膜结节型32．2％，腹膜溃疡型22．6％，腹腔肿块型22．6％，腹膜浸润型13．2％，网膜包裹型9．4％。腹膜恶性肿瘤肿瘤病理学诊断结果：淋巴瘤17．0％，间质瘤15．1％，腹膜粘液细胞癌11．32％，腹膜间皮瘤11．32％，腹膜转移癌45．3％。24例腹腔转移癌的组织来源：卵巢癌腹腔转移29．2％，胃癌腹腔转移16．6％，结肠癌腹腔转移12．5％，原发性肝癌腹腔转移12．5％，胰腺癌腹腔转移8．3％，十二指肠乳头癌腹腔转移4．2％、胆管细胞癌腹腔转移4．2％，原发病灶不明者12．5％。结论NOTES腹腔内镜探查对腹膜病变检查直观性强，获取病理标本靶向性好，是诊断腹膜恶性肿瘤的安全有前方法。

Value of NOTES and peritoneoscopy in diagnosis of peritoneal malignant tumors

Objective To evaluate the value of natural-orifice transluminal endoscopic surgery （NOTES） and peritoneoscopy in diagnosis of patients with peritoneal malignant tumors. Methods The data on findings of transgastric NOTES and peritoneoscopy, pathological examination of biopsies and origin of tumors were analyzed retrospectively. Results In 53 patients with peritoneal malignant tumors, peritoneoendoscopie findings were divided into five types, i.e., peritoneal mnodular type of tumor 32.2%, peritoneal ulcer type of tumor 22.6%, peritoneal cavity mass type of tumor 22.6%, peritoneal infiltration type of tumor 13.2%, and omentum-embrace type of tumor 9.4%. Pathological results were that lymphoma accounted for 17.0%, strmomal tumorlS.l%, peritoneal myxocyte carcinoma 11.32%, peritoneal mesohyloma ll.32%,peritoneal metastatic carcinoma 45.3%. Sources of peritoneal carcinomas were that ovarian cancer had 29.2%, gastric cancer 16.6%, colon cancer 12.5%, primary liver cancer 12.5%, pancreatic cancer 8.3%, duodenal papillary cancer 4.2%, biliary cell carcinoma 4.2%, and unknown origin of tumor 12.5% in 24 patients with peritoneal metastatic carcinomas. Conclusion NOTES and peritoneoseopy with intuitive endoscopic examination and targeted biopsy of the suspicious tissue has important value in the diagnosis, the types and origin of peritoneal malignant tumors.