腹腔镜探查诊断结核性腹膜炎价值探讨-外科学专业论文.docxVIP

— — PAGE 1— 摘 要 腹腔镜探查诊断结核性腹膜炎价值探讨 研究生：陈勇 导师：克力木.阿不都热依木 教授 摘 要 目的：探讨腹腔镜探查诊断结核性腹膜炎的价值。方法：对新疆维吾尔自治区人 民医院自2008年1月至2008年12月收治的65例怀疑结核性腹膜炎的病人行腹腔镜腹 腔探查活检术。最终34例病人临床确诊为结核性腹膜炎。将65例病人腹腔镜探查直 视下诊断结果与病检结果进行比较。将不同常规影像学检查诊断符合率进行比较。 将常规辅助检查费用之和与腹腔镜探查费用，常规辅助学检查花费时间之和与腹腔 镜检查花费时间进行比较。比较结核性腹膜炎病人与腹腔内广泛转移腺癌病人入院 时的血清CA125值；比较结核性腹膜炎病人入院时与正规抗痨治疗三个月后血清 CA125值。结果：腹腔镜直视诊断结核性腹膜炎敏感度SEN = 93.75%；特异度SPE = 90.91%；准确度ACC = 92.31%；误诊率α = 9.10%；漏诊率β = 6.25；Youden指数 YI = 0.8466；阳性预测值 +PV = 90.91%；阴性预测值 -PV = 93.75%；阳性似然比 +LR = 10.3022；阴性似然比 -LR = 0.0687；粗一致率0.9231；卡帕值Kappa0.8462；符合 率0.9231。手术并发症：肠管损伤2例；切口不愈合，二期缝合1例。手术后一过性发 热7例。不同常规影像学检查诊断符合率无差异（P0.05）。常规检查费用之和较腹 腔镜探查费用多，两者比较有统计学差异（P0.05）。常规检查花费时间之和较腹腔 镜检查花费时间明显长，两者比较有统计学差异(P0.01)。发病入院时结核性腹膜炎 与腹腔内广泛转移癌病人血清CA125值无统计学差异（P0.05）；结核性腹膜炎病人 入院时的血清CA125值与正规抗痨治疗三个月后血清CA125值两者比较有统计学差 异(P0.01)。结论：腹腔镜探查诊断结核性腹膜炎效率高，安全可行，而且经济，省 时。但有学习曲线和一定的并发症。血清肿瘤标记物CA125值的变化可作为评判结 核性腹膜炎治疗效果的一种指标。 关键词：腹腔镜检查；结核性腹膜炎；诊断 新疆医科大学医学硕士学位论文 Diagnostic value of laparoscopy in Tuberculous Peritonitis Postgraduate:Chenyong Supervisor:Prof.Kelimu.abudureyimu Abstract Objective: To assess the value of laparoscopic exploration in diagnosing tuberculous peritonitis . Methods: A total of 65 patients with doubted tuberculous peritonitis underwent diagnostic Laparoscopic abdominal exploration and biopsy in which the patients were treated in people’s hospital in Xinjiang Uygur Autonomous Region from January 2008 to December2008.There was 34 cases were proved. We compared the diagnosis between laparoscopic finding and biopsy;the diagnose accordance rates of different conventional diagnostic imaging examinations;Charge and time of routine examination and laparoscopic exploration of the 65 cases; the level of CA125 in serum in 2 groups (including 34 cases of tuberculous peritonitis,21 cases of abdominal extensive metastatic adenocarcinoma )on admission.We measured the CA125 values of tuberculous peritonitis patients on admissions and compared them with which had a irregular antituberculosis treatment afte