腹腔镜在原因不明腹水患者诊治中的价值  

The value of laparoscopy in diagnosis and treatment of patients with unknown origin ascites

作　　者：丁西来[1] 樊庆泊[1] 冷金花[1] 郎景和[1] 刘珠凤[1] 孙大为[1] 朱兰[1] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院妇产科,北京100730

出　　处：《生殖医学杂志》2012年第3期201-204,共4页Journal of Reproductive Medicine

摘　　要：目的研究腹水待查患者腹腔镜检查的意义,及对临床诊断和治疗的指导作用。方法回顾性分析1986年1月至2009年1月北京协和医院收治的24例妇科盆腔检查、影象学检查均未见明显异常的腹水待查患者行腹腔镜检查的临床资料。结果 24例中经腹腔镜明确诊断21例,其中卵巢癌10例,结核性腹膜炎7例,卵巢交界性粘液性囊腺瘤1例,腹膜恶性间皮瘤1例,肝硬化性腹水2例。卵巢癌患者的平均年龄(54.6岁)高于结核性腹膜炎患者(45岁)。卵巢癌患者血清CA125平均值(4064.1 IU/ml)明显高于结核性腹膜炎患者(352.4 IU/ml)。结论腹腔镜检查对原因不明的腹水待查患者明确诊断和治疗具有重要指导作用;对于妇科检查和影像学检查均未见明显异常的腹水待查患者,尤其是高血清或腹水CA125值患者,应高度警惕卵巢癌的可能。Objective： To assess whether laparoscopy is a reliable technique for diagnosis of patients with un- known origin ascites. Methods： Data of twenty-four patients with ascites whose diagnosis remained obscure after extensive nonoperative diagnostic work-up were retrospectively analyzed. Results. The twenty four patients were underwent the laparoscopic exploration, and 21 patients had clear diagnosis. Among the 21 patients, 10 patients were diagnosed as ovarian cancer, 7 patients with peri- toneal tuberculosis, 1 patient with ovarian borderline mucosal cystadenoma, 1 patient with malignant mes- othelioma, and 2 patients with hepatic cirrhosis. The average age of patients with ovarian cancer （54. 6 years） was higher than that of patients with peritoneal tuberculosis （45 years）. The patients with ovarian cancer had much higher levels of CA125 in serum （4,064.1 IU/ml） than the patients with peritoneal tuber- culosis （352.4 IU/ml）. Conclusions： Laparoscopy is a valuable means for assessing the peritoneal cavity in patients with un- known etiological ascites. The diagnosis can be accurately made with selective biopsy specimens, and ap- propriate treatment can be instituted without delay.

关 键 词：腹水 卵巢癌 结核 肝硬化 腹腔镜 

分 类 号：R[医药卫生]