经自然腔道内镜手术检查诊断结核性腹膜炎20例.pdfVIP

经自然腔道内镜手术检查诊断结核性 腹膜炎20例 朱惠明 李迎雪 王立生 师瑞月 黄勋 王琴 罗伟香 [摘要] 目的 探讨经胃的经自然腔道内镜手术(NOTES)腹腔内镜检查对结核性腹膜炎的诊 断价值。方法 回顾20例经胃NOTES腹腔内镜检查及病理活检确诊为结核性腹膜炎患者的相关临 床资料,并进行性分析总结。结果 20例患者经胃NOETS腹腔内镜检查及病理活检后明确诊断为 结核性腹膜炎。内镜检查结果为4型：(1)粟粒型：内镜表现为腹水、腹膜散在分布白色粟粒状结节； (2)粘连型：内镜表现腹膜增厚,腹膜与网膜、肠管之间存在不同程度的粘连；(3)干酪型：内镜表现壁 层溃疡及淡黄色干酪样物质；(4)混合型：内镜表现为同时存在2种或3种类型。其他各项实验室及 特殊检查的阳性例数分别为血红蛋白下降10例,红细胞沉降率增快16例,C反应蛋白升高13例, CA125升高18例,胸片异常8例,腹部彩超异常2例,腹部CT异常7例,结核菌素实验阳性9例,结 肠镜检查阳性1例,20例结核抗体、腹水培养、腹水细菌学检查、胃镜检查均阴性。结论 经胃 NOTES腹腔内镜检查及病理活检是确诊结核性腹膜炎非常有效的诊断方法。 经自然腔道内镜手术；腹膜炎,结核性；腹水；诊断 Trans-gastric peritoneoscopy with technique of natural-orifice transluminal endoscopic surgery for di agnosis of tuberculosis peritonitis: a report of 20 cases ZHU Hui-mingLI Ying-xueWANG Li-sheng SHI Rui-yueHUANG XunWANG QinLUO Wei-xiangDepartment of Gastroenterology, Shenzhen Peoples Hospital, Second Clinical Medical College, Jinan University, Shenzhen 518020 , China [ Abstract] Objective To investigate the diagnostic value of trans-gastric peritoneoscopy with tech nique of natural orifice transluminal endoscopic surgery (NOTES) for tuberculosis peritonitis. Methods Clinical data of 20 patients with tuberculosis peritonitis diagnosed by trans-gastric peritoneoscopy via NOTES were retrospectively analyzed. Results All diagnoses were confirmed by biopsy. The findings of peritoneos copy were defined as miliary type with miliary nodes scattered in ascites and on peritoneum, adhesive type with thickening of peritoneum and adhesion between peritoneum and intestines, cheese-like type with parietal peritoneal ulcer and cheese-like substances, and mixed type with 2 or 3 of above mentioned types. Positive findings in other laboratory examinations were hemoglobin decrease in 10 (50％) patients, blood sedimenta tion rate increase in 16 (80％), C reactive protein increase in 13 (65％), CA125 increase in 18 (90％), and positive tuberculin test in 9 (45％). Abnormal findings were detected by ch