小口径腹腔镜检查对结核性腹膜炎的诊断价值:21例临床分析

Diagnostic Value of Mini-laparoscopy in Tuberculous Peritonitis: Clinical Analysis of 21 Cases

背景:结核性腹膜炎临床表现常不典型,误诊、漏诊率较高。目的:探讨小口径腹腔镜检查对结核性腹膜炎的诊断价值和安全性。方法:回顾性分析2006年1月～2007年12月于复旦大学附属中山医院行小口径腹腔镜检查,最终诊断为结核性腹膜炎的21例患者的一般情况、腹腔镜表现和实验室、辅助检查结果。结果:1例患者因腹腔严重黏连而终止检查;20例(95.2%)腹腔镜直视可见腹腔内弥漫粟粒样结节,结合临床表现诊断为结核性腹膜炎,其中17例(81.0%)取得活检组织,经病理检查明确诊断。21例患者中,渗出型11例(52.4%),黏连型7例(33.3%),干酪型3例(14.3%)。术后并发症发生率为9.5%,包括穿刺部位出血和皮下气肿各1例。小口径腹腔镜直视诊断阳性率显著高于结核菌素纯蛋白衍生物(PPD)试验、腹水乳酸脱氢酶(LDH)、血清和腹水肿瘤相关糖链抗原125(CA125)、腹水腺苷脱氨酶(ADA)检测等(P<0.05)。结论:小口径腹腔镜检查用于诊断结核性腹膜炎,操作简便、安全,诊断准确性高。

Background： The clinical manifestations of tuberculous peritonitis are usually atypical, which may result in misdiagnosis and missed diagnosis clinically. Aims： To assess the diagnostic value and safety of mini-laparoseopy in patients with tuberculous peritonitis. Methods： Twenty-one patients undergoing mini-laparoscopy finally were diagnosed as having tuberculous peritonitis, and were enrolled in this study from Jan. 2006 to Dec. 2007 in Zhongshan Hospital, Fudan University. Their general conditions, laparoscopic findings, as well as results of laboratory and adjuvant examinations were analyzed retrospectively. Results： Under laparoscopy, miliary nodules scattered over the peritoneum were observed in 20 patients （95.2%）, with failure in one patient because of adhesions within the abdominal cavity. Biopsy specimens were obtained successfully in 17 patients （81.0%）, and the diagnoses were confirmed path？logically. Of the 21 patients, 11 （52.4%） were exudative type, 7 （33.3%） were adhesive type, and 3 （14.3%） were caseous type. The incidence of postoperative complications was 9.5%, including one puncture site bleeding and one subcutaneous emphysema. The diagnosis rate of mini-laparoscopy was significantly higher than that of purified protein derivative of tuberculin （PPD） test, ascitic lactate dehydrogenase （LDH）, serum and ascitic tumor-associated carbohydrate antigen 125 （CA125）, and ascitic adenosine deaminase （ADA） （P〈0.05）. Conclusions： Mini-laparoscopy is an easy, safe and accurate modality for the diagnosis of tuberculous peritonitis.