152例腹膜活检在良恶性腹水鉴别中的临床实用性分析  

The practical value of peritoneum biopsy examination on the differential diagnosis of benign and malignant ascites in clinic

作　　者：刘东屏[1] 赵梅芬[1] 王学梅[1] 王炳元[1] 

机构地区：[1]中国医科大学附属第一医院消化内科,辽宁沈阳110001

出　　处：《中国医师杂志》2007年第10期1338-1340,共3页Journal of Chinese Physician

基　　金：辽宁省沈阳市科委研究课题资助项目（[2004]36号）

摘　　要：目的评价比较同步进行的腹膜活检、腹水肿瘤标志物测定、腹水脱落细胞学检查在良恶性腹水鉴别诊断中的临床实用价值。方法152例腹水原因待查患者,经B超检查均有不同程度不同部位的腹膜增厚,在超声穿刺探头引导下于增厚的腹膜处进行活检,组织石蜡包埋,HE染色后作病理学诊断。腹水肿瘤标志物AFP、CEA、CA199、CA125检测方法为电化学发光法,腹水肿瘤的细胞学检查采用腹水离心后沉渣包埋免疫组化染色。结果腹膜活检检出阳性率为96.1%（146/152）,明显高于腹水脱落细胞学检查的阳性率17.12%（25/146）,差异有统计学意义（P〈0.01）,腹水肿瘤标志物AFP、CEA值在恶性腹水中有明显升高,但敏感性仅为36.6%（30/82）和46.43%（38/82）,特异性分别为76.56（49/64）和54.69（35/64）,敏感性和特异性均较差,CA199和CA125的值在良恶性腹水中差异无统计学意义,特异性和准确性均不高,故认为腹水肿瘤标志物临床应用价值有限。结论腹膜穿刺活检是一种优于腹水脱落细胞学检查和肿瘤标志物的最有临床价值的检查手段,对于原因不明伴有腹膜增厚的腹水的诊断,腹膜穿刺活检应作为首选的诊断性检查方法。Objective To evaluate the clinical value of peritoneum biopsy, ascetic tumor-maker and ascetic cytological examination processed simultaneously on the differential diagnosis of benign and malignant ascites. Method 152 cases ascetic patients with uncertain diagnosis was selected, and all with thickened peritoneum of different degree and different site. The thickened peritoneums were punctured for biopsy leading by ultrasonic puncture probe. The biopsy tissues were embedded in paraffin and stained by HE method for pathological diagnosis. The ascetic tumor-makers （AFP, CEA, CA199, CA125） were detected by electrochemilluminant method, and the ascetic sediment was embedded and stained by immunobiochemical method for neoplastic cytological examination of ascites. All data was analyzed by statistical analysis software SPSS11.5, the comparison of each group was done by t test, the comparison of positive rate was done by x2 test. Result The positive rate of peritoneum biopsy is apparently higher than that of ascetic cytological examination. The ascetic tumor-marker AFP and CEA have poor sensitivity in peritoneum metastatic carcinoma. CA199 and CA125 have poor specificity in differential diagnosis of benign and malignant ascites. Conclusion Puncturing biopsy of peritoneum is the most valuable diagnostic method and the first choice in clinic for uncertain ascites with thickened peritoneum. ]

关 键 词：腹水/诊断 活组织检查 腹膜/病理学 诊断 鉴别 

分 类 号：R730[医药卫生—肿瘤]