76例腹膜转移癌的临床检查方法对比分析

The analysis of clinical examinations for 76 cases of peritoneal metastatic carcinoma

目的:比较腹膜活检和腹水脱落细胞学检查及临床常用的辅助检查方法,评价腹膜活检在腹膜转移癌诊断中的作用和临床实用价值。方法:76例腹膜活检诊断为腹膜转移癌者,经B超检查均有不同程度、不同部位的腹膜增厚,采用超声穿刺探头引导下经皮于增厚的腹膜处进行活检,组织石蜡包埋,HE染色后作病理学诊断,所有的患者均行腹水脱落细胞学、内窥镜、B超、CT、X线等检查寻找肿瘤可能的原发病灶。结果:76例腹膜转移癌均由腹膜活检证实,同步细胞学检查发现瘤细胞者23例,阳性率为30.3%,内窥镜发现胃肠道肿瘤病灶者32例,阳性率为42.1%,超声/CT发现腹部病灶者29例,阳性率为38.2%,内窥镜加超声发现腹膜转移癌总的阳性率为80.3%。结论:不明原因的腹水,当临床高度疑诊腹膜转移癌时,尤其当临床无创性检查没发现肿瘤病灶时,腹膜穿刺活检是有用的检查手段。

Objective：To compare peritoneum biopsy with ascetic exfoliative cytology and clinical commonly used auxiliary examination methods, evaluate the role and clinical practical value of peritoneum biopsy in the diagnosis of peritoneal metastatic carcinoma. Methods：Seventy six patients were diagnosed peritoneal metastatic carcinoma by peritoneum biopsy, and all patients with thickened peritoneum of different degree and different site by B uhrasonograph, and puncturing the thickened peritoneum for biopsy leading by ultrasonic puncture probe. Embedding the biopsy tissue in paraffin and staining by HE method for pathological diagnosis ,and all patients were detected ascetic exfoliative cytology,introscope, B uhrasonograph, CT and abdominal X ray examination in order to search possible primary lesion of tumor. Results：Seventy six patients were confirmed peritoneal metastatic carcinoma by peritoneum biopsy, cytological examination diagnosed 23 cases synchronously,the positive rate was 30.3% ,introscope diagnosed 32 cases gastroenteric tumor, the positive rate was 42.1% , B uhrasonograph/CT finded 29 cases abdominal focus of tumor, the positive rate was 38.2%, introscope and ultrasonograph finded peritoneal metastatic carcinoma, the overall positive rate was 80.3%. Conclusion： When ascetic patients with uncertain diagnosis were doubted peritoneal metastatic carcinoma highly, especially no wounding examination in clinic can not find tumor,peritoneum puncturing biopsy should be the useful diagnostic method.