腹腔镜检查对腹膜病变的诊断价值

目的 研究腹腔镜检查及直视下腹膜活检对腹膜病变的诊断价值。方法 应用MachidaFLA-8腹腔镜及直视下腹膜活检诊断腹膜病变。结果 腹腔镜检查及直视下腹膜活检131例中，122例（93.1%)活检病理诊断阳性，其中结核性腹膜炎（TBP）63例，腹膜癌（PC）56例，腹膜恶性间皮瘤2例，腹膜恶性淋巴瘤1例，TBP临床误诊率为58.8%。而PC为91.1%。TBP的腹腔镜性间皮瘤2例，腹膜恶性淋巴瘤1例，TBP临床误诊率为58.8%，而PC为91.1%，TBP的腹腔镜所见主要为腹膜与邻近脏器表面有比较均匀一致的粟粒样白色结节，常散在或成群地分布于腹膜上活检时组织较软。而PC的所见主要是腹膜与邻近脏器表面有大小不一的灰白色斑块和结节，活检时有明显的坚硬感。结论 腹膜病变临床诊断困难，误诊率高，腹腔镜检查及直视下腹膜活检是最有效的诊断方法，可以确定诊断。

Diagnostic value of laparoscopy and direct vision peritoneal biopsy in peritoneal diseases

Objective To study the diagnostic value of laparoscopy and direct-vision peritoneal biopsy in peritoneal diseases. Methods Peritoneal diseases have been diagnosed under laparoscopy,( model Machida FLA-8),by direct-vision peritoneal biopsy. Results Totally 131 patients underwent laparoscopy and direct-vision peritoneal biopsy,122 cases (93.1%)were positive by pathological analysis, including 63 cases of tuberculous peritonitis (TBP), 56 cases of peritoneal carcinoma (PC), 2 cases of peritoneal malignant mesothelioma and one case of peritoneal malignant lymphoma. Clinical misdiagnostic rateswere TBP 58.8% and PC 91.1% . Under laparoscopy the TBP appeared as evenly distributed millet-like white nodules with soft consistency,while PC,as unevenly distributed grayish-white spots or nodules with solid hard consistency.Conclusion It is difficult to diagnose peritoneal diseases only from their clinical features while laparoscopy and direct-vision peritoneal biopsies is a very efficient and accurate diagnostic means in this field.