经皮超声引导下腹膜穿刺活检诊断结核性腹膜炎的临床实用性分析  

Clinical outcome analysis of epiploon biopsy in the diagnosis of patients with tuberculous peritonitis

作　　者：刘东屏[1] 贺庆娟[1] 王学梅[2] 孙明军[1] 

机构地区：[1]中国医科大学附属第一医院消化科,辽宁省沈阳市110001 [2]中国医科大学附属第一医院超声诊断科,辽宁省沈阳市110001

出　　处：《世界华人消化杂志》2008年第5期567-569,共3页World Chinese Journal of Digestology

基　　金：沈阳市科委基金;No.2004-36~~

摘　　要：目的:评价腹膜活检在结核性腹膜炎诊断中的临床实用性.方法:152例腹水原因待查患者,采用超声穿刺探头引导下经皮于增厚的腹膜处进行活检,活检组织行病理学检查,所有患者均进行PPD、血沉、血清C反应蛋白(CRP)和腹水乳酸脱氢酶(LDH)、腹部X线检查.结果:腹膜活检的成功率为96.05%,结核性腹膜炎64例,占腹膜活检者的42.11%.152例腹膜活检患者中,诊断为结核性腹膜炎者64例,占总不明原因腹水42.11%,腹膜活检阳性率明显高于目前用于临床提示结核性腹膜炎的一般性辅助检查包括血沉增快(x^2=1.265,P =0.261)、PPD阳性(x^2=26.669,P=0.000)、CRP升高(x^2=8.125,P=0.004),腹水LDH增高(x^2=20.403,P=0.000)、腹部X线检查阳性所见(x^2=7.169,P=0.007),统计处理差异显著.腹膜活检病理组织内可见结核的病理改变:干酪样坏死,朗罕氏细胞、类上皮细胞及多核巨细胞,组织内有大量纤维脂肪组织.结论:经皮腹膜穿刺活检可以确诊结核性腹膜炎,安全可靠,使用限制少,是一种最具有临床实用价值的检查手段.AIM： To evaluate the clinical practical value of epiploon biopsy in the diagnosis of tuberculous peritonitis. METHODS： A total of 152 ascetic patients with uncertain diagnosis were selected to puncture the thickened peritoneum under the guidance of ultrasonic puncture probe. Biopsy tissue was sent for pathological examination. Serum PPD, ESR and CRP were and LDH in ascites were detected. Abdomen was examined by X-rays. RESULTS： The success rate of epiploon biopsy was 96.05%. Of the 152 patients, 64 were diagnosed as tuberculous peritonitis, accounting for 42.11% of ascetic patients with uncertain diagnosis. The positive rate of epiploon biopsy was obviously higher than that of traditional clinical examinations. Serum ESR （Χ^2 = 1.265, P = 0.261）, PPD （Χ^2 = 26.669, P = 0.000）, CRP （Χ^2 = 8.125, P = 0.004） and LDH in ascites （Χ^2=20.403, P = 0.000） and positive findings of abdominal X-ray findings （Χ^2=7.169, P = 0.007） were increased in tuberculous peritonitis patients with a significantly statistical difference （P 〈 0.05）. Following pathologic findings of TB were observed in peritoneal tissue samples： cheese necrosis, Langhan＇s cells- like and epithelial cells-like multinucleated giant cells, a large number of fibers within adipose tissue. CONCLUSION： Percutaneous biopsy can be confirmed tuberculosis peritonitis, secure, reliable, less restriction on the use, is one of the most practical clinical means of inspection.

关 键 词：腹膜活检 结核性腹膜炎 腹水 

分 类 号：R526[医药卫生—内科学] R169.42[医药卫生—临床医学]