腹腔镜在女性不明原因腹水症中的应用  

Laparoscopic exploration in ascites of unknown causes

作　　者：刘晓军[1] 刘彦[1] 金志军[1] 李文[1] 郭晓杰[1] 侯庆香[1] 

机构地区：[1]第二军医大学附属长征医院妇产科,上海200003

出　　处：《中国实用妇科与产科杂志》2003年第11期675-676,共2页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的　探讨腹腔镜在女性不明原因腹水症中的诊断价值及腹腔镜在此类患者中的手术操作技巧。方法　 1999年 7月至 2 0 0 2年 10月在全麻下对 2 8例不明原因女性腹水症患者进行腹腔镜探查 ,并取可疑组织送病理检查 ,分析腹腔镜探查和所取组织的病理结果。结果　腹腔镜手术探查阳性结果 2 4例 ,阳性率 85 7% ,其中结核性腹膜炎 8例 ,占 2 8 6 % ;腹膜间皮瘤 5例 ,占 17 9% ;其他分别为转移性腺癌、卵巢外腹膜浆液性乳头状癌、肝硬化、结肠淋巴漏。阴性者 4例 ,阴性率为 14 3%。由于采用了改良开放式第 1穿刺、控制腹腔压力及提高第 2、3穿刺孔的位置等措施 ,在不明原因腹水症患者中行腹腔镜探查术无一例出现并发症。结论　腹腔镜探查腹水病因是一种安全有效的诊治方法 ,通过镜下观察及取病理检查可以确定产生腹水的原因。腹腔镜探查术应用于腹水患者的诊治 ,操作技巧有其特殊性。Objective To investigate the diagnostic role and surgical technique of laparoscopic exploration in women with ascites of unknown causes.Methods From July 1999 to October 2002,laparoscopic exploration was performed in 28 ascetic patients with unknown causes and the suspected tissue was taken for pathologic examination.The result of the laparoscopic exploration and pathologic examination were analyzed.Results Twenty four cases were positive by laparoscopic exploration,the positive rate being 85 7%.The major cause was tuberculous peritonitis(28 6%);the secondary cause was peritoneal mesothelioma(17 9%).Other causes were metastatic adenocarcinoma,extraovarian peritoneal serous papillocarcinoma,hepatocirrhosis and colonic lymphorrhea.The causes of 4 cases remained unknown,the negative rate being 14 3%.Due to the reform of puncture method and sites and controlling the abdominal pressure,no complication was found in our exploration.Conclusion Laparoscopic exploration is safe and effective for diagnosing and treating ascites;laparoscopic and histopathological examination can reveal the causes for ascites.Laparoscopy exploration requires special operational technique.

关 键 词：腹腔镜 女性 不明原因腹水症 诊断 探查术 

分 类 号：R442.5[医药卫生—诊断学] R71[医药卫生—临床医学]