超声引导下穿刺活检对不明原因难治性腹水的诊断价值

The diagnostic value of ultrasound guided aspiration biopsy in unexplained refractory ascites

目的探讨超声引导下穿刺活检对临床不明原因难治性腹水的诊断价值。方法回顾性分析25例不明原因的难治性腹水患者,对增厚腹膜或腹水中包块进行超声引导下穿刺活检。结果超声检查发现腹膜局限性增厚病变10例,均呈中等或中等偏低回声,其中2例进行超声造影,均显示增厚的腹膜动脉期明显增强,造影剂于静脉期快速退出。腹膜不规则增厚伴网膜粘连、聚集,部分形成网膜饼样结构7例,腹膜或腹水中囊性包块5例,飘浮于腹水中的腹部实性包块2例,无明确包块仅见胰腺肿大1例。病理检查显示25例患者中恶性病变20例,其中恶性间皮瘤6例,胰腺囊腺癌2例,转移性腺癌9例,恶性神经鞘瘤、淋巴瘤、恶性纤维组织细胞瘤各1例。良性病变5例,其中结核3例,炎性病变和腹膜后纤维化各1例。5例良性病变均经半年以上的随访证实。结论难治性腹水中的腹膜增厚性病变及腹水中的较小肿块行超声引导下穿刺活检,对于临床明确诊断具有较高的参考价值。

Objective To explore the diagnostic value of ultrasound-guided aspiration biopsy in patients with unexplained refractory ascites. Methods The data of 25 cases of unexplained refractory ascites were retrospectively analyzed. For all the cases the diagnosis was based on the examination of contrast enhanced CT or ultrasound. Ultrasound-guided aspiration biopsy of locally thickened peritoneum or tiny masses in ascites was performed. Results Uhrosonographic image of all cases was as follows. 10 cases, with locally thickened peritoneurn, were isoechoic or hypoechioc. In 2 of 10 cases contrast enhanced ultrasound examination was done, and the images were characterized by an obvious enhancement in arterial phase and quick wash-out in veinous phase. In 7 cases there was irregularly thickened peritoneum, accompanied by adhesion and caking of the ornenturn. Cystic formation in ascites or in peritoneum was found in 5 cases. Solid mass in ascites was found in 2 cases, and splenornegaly and enlarged pancreas were found in 1 cas. Ultrasound-guided aspiration biopsy was perforned in all the patients. Among them 4 patients were operated on later. Histopathologic examination showed malignency in 20 patients. Among them, malignant peritoneal rnesothelioma accoumted for 6 cases, pancreatic cystoadenoma in 2, rnestastic adenocarcinoma in 9, malignant schwannoma in 1, lymphoma in 1, and histiocytoma in 1 patient. In the other 5 cases the lesion was benign, and it was verified by followup for about 6 months. Among them there were 3 cases of tuberculosis, 1 case of inflammatory disease and 1 case of retroperitoneal fibrosis. Conclusion Ultrasound-guided aspiration biopsy is valuable in the diagnosis of locally thickened peritoneum and tiny mass in ascitic fluid, and is valuable for diagnosis of unexplained refractory ascites.