腹膜活检在良恶性腹水鉴别中的临床实用价值  

Practical clinical value of peritoneum biopsy, ascetic tumor-maker and ascetic cytological examination on the differential diagnosis of benign and malignant ascites

作　　者：刘东屏[1] 陶春梅[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：《中国现代医学杂志》2009年第5期780-781,784,共3页China Journal of Modern Medicine

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及不同部位的腹膜增厚,采用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,腹水肿瘤细胞学检查采用腹水离心后沉渣包埋免疫组化染色。腹水肿瘤标志物AFP、CEA、CA199、CA125检测采用电化学发光法。结果腹膜活检检出阳性率为100%(146/146),明显高于腹水脱落细胞学检查的阳性率17.12%(25/146),差异有显著性(P<0.01),腹水肿瘤标志物AFP、CEA在恶性腹水中有明显升高,但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显著性。故认为腹水肿瘤标志物临床应用价值有限。结论对于原因不明的伴有腹膜增厚的腹水的诊断,腹膜穿刺活检是一种最有临床价值的首选诊断方法。[Objective] To evaluate the practical clinicalvalue of peritoneum biopsy, ascetic tumor-marker and ascetic cytological examination processed simultaneously on the differential diagnosis of benign and malignant ascites. [Method] 152 cases ascetic patients with uncertain diagnosis were selected, and all with thickened peritoneum of different degree and different site, and puncturing the thickened peritoneum for biopsy leading by ultra- sonic puncture probe. Embedding the biopsy tissue in paraffin and staining by HE method for pathological diagnosis the ascetic sediment is embedding and stained by immunobiochemical method for neoplastic cytological examination of aseites, detecting the ascetic tumor-marker （AFP, CEA, CA199, CA125） by electrochemilluminant method,[Results ] The positive rate of peritoneum biopsy is apparently higher than that of ascetic cytological examination. The ascetic tumor-marker AFP and CEA are apparently higher in peritoneum metastatic carcinoma, but with poor sensitivity. CA199 and CA125 have poor specificity of in differential diagnosis of benign and malignant ascites, so are not practical in clinic. [Conelusion] 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：腹膜活检 腹水细胞学检查 肿瘤标志物 

分 类 号：R73-74[医药卫生—肿瘤]