腹膜疾病诊断42例

Diagnosis of patients with peritoneal diseases:an analysis of 42 cases

目的:对42例腹膜病变患者临床资料进行分析,以提高该类疾病的诊断水平.方法:42例腹膜病变患者,男22例,女20例,年龄17-89岁,平均54岁.对所有患者进行CT与血清肿瘤标志物检查、40例行腹穿术、9例行PET/CT检查、13例行超声引导下经皮腹膜活检术.分析腹膜病变的病因和各诊断方法的灵敏性、特异性和准确性.结果:血清CEA、CA153、CA19-9、CA242和CA125对腹膜恶性肿瘤诊断的灵敏性分别为14.8%、18.5%、29.6%、22.2%及100%,特异性分别为80.0%、93.3%、93.3%、93.3%及0%.腹水脱落细胞对腹膜恶性病变诊断的灵敏性为36%,特异性为100%;腹水ADA对腹膜结核性病变诊断的灵敏性为92.3%,特异性为92.5%.8例CT检查结果支持最后诊断,准确率为19%;7例PET/CT检查结果支持最后诊断,准确率为78%;11例腹膜活检术结果支持最后诊断,准确率为85%.结论:肿瘤标志物、腹水脱落细胞和ADA检查对腹膜炎性与肿瘤性病变的鉴别有一定的辅助意义.PET/CT和腹膜活检对腹膜病变诊断的准确性明显高于CT.

AIM：To evaluate the clinical value of different methods for diagnosis of peritoneal diseases.METHODS：A total of 42 patients with peritoneal diseases were included in the study.Measurement of serum tumor markers and computed tomography （CT） were performed in all patients,peritoneocentesis in 40 patients,positron emission tomography （PET）/CT in 9 patients,and ultrasound-guided percutaneous peritoneal biopsy in 13 patients.The sensitivity,specificity and accuracy of each method and the causes of peritoneal diseases were analyzed.RESULTS：The sensitivity of measurement of serum tumor markers （CEA,CA153,CA19-9,CA242 and CA125） in the diagnosis of metastatic peritoneal tumors was 14.8%,18.5%,29.6%,22.2% and 100%,and the specificity was 80.0%,93.3%,93.3%,93.3% and 0%,respectively.The sensitivity and specificity of exfoliative cytologicexamination in the diagnosis of carcinous ascites were 36% and 100%,respectively.The sensitivity and specificity of ascites adenosine deaminase （ADA） in the diagnosis of tuberculous ascites were 92.3% and 92.5%,respectively.The accuracy of CT,PET/CE and percutaneous peritoneal biopsy was 19%,78% and 85%,respectively.CONCLUSION：Serum tumor marker measurement,exfoliative cytologic examination and ascites ADA can help differentiate between carcinous and inflammatory peritoneal diseases.The accuracy of PET/CT and percutaneous peritoneal biopsy is higher than that of CT.