经自然腔道腹腔内镜检查在腹膜转移癌诊断中的应用

Value of peritoneoscopy via natural orifice transluminal endoscopic surgery in the diagnosis of peritoneal carcinomatosis

目的评价经自然腔道内镜手术（NOTES）在腹膜转移癌诊断中的价值。方法回顾性分析2007年4月至2010年10月收治的32例经病理活检确诊的腹膜转移癌患者的临床资料，胃肠镜、影像学、腹水细胞学和经胃腹腔内镜检查结果。结果32例患者经消化内镜检查发现消化道肿瘤9例（28．1％），经影像学检查疑诊卵巢占位性病变8例（25．0％）、胰腺癌2例（6．3％）、原发性肝癌2例（6．3％）、胆管细胞癌1例（3．1％），但均未确诊有腹膜转移癌。腹水细胞学检阳性6例（18．8％）。经胃腹腔内镜检查及病理活检后均确诊腹膜转移癌。32例腹膜转移癌患者的经胃腹腔内镜下腹膜病变表现为5型：（1）肿块型3例（9．4％）：局部腹膜壁层单个或多个直径≥2cm的肿物；（2）结节型5例（15．6％）：腹膜壁层多个大小不等的结节性病变；（3）溃疡型1例（3．1％）：腹膜壁层溃疡性病变；（4）网膜包裹型1例（3．1％）：网膜挛缩，与肠管粘连，包裹肠管使之成为饼状；（5）混合型22例（68．8％）：同时存在2种或2种以上类型。结论经胃腹腔内镜检查及组织活检对确诊腹膜转移癌及其内镜表现类型具有重要价值。

Objective To evaluate the value of peritoneoscopy via natural orifice transluminal endoscopic surgery （NOTES） in the diagnosis of patients with peritoneal carcinomatosis. Methods A total of 32 patients with peritoneal carcinomatosis were diagnosed by histological examination of biopsies at our hospital from April 2007 to October 2010. Their data of clinical manifestations, gastroscopy, colonoscopy, abdominal uhrasonography, abdominal computed tomography, magnetic resonance imaging, ascitic cytology and transgastric peritoneoscopy via NOTES were analyzed retrospectively. Results Among them, gastrointestinal cancers were diagnosed by digestive endoscopy in 9 cases （28. 1% ）. And ovarian lesions in 8 cases （25.0%）, pancreatic cancer in 2 cases （6. 3% ） , primary liver cancer in 2 cases （6. 3% ） and bile duct carcinoma in 1 case （3. 1% ） were suspected according to imaging examinations. No peritoneal carcinomatosis was found by digestive endoscopy or imaging examinations. Ascitic cytology was positive in 6 cases （ 18.8% ）. Peritoneal carcinomatosis was diagnosed by transgastric peritoneoscopy via NOTES with histological examination of biopsies in all patients. Their findings of transgastric peritoneoscopy via NOTES were divided into 5 types, i. e. , mass type （ n = 3,9.4% ）, nodular type （ n = 5,15.6% ）, ulcerative type （ n = 1,3.1% ）, omentum-embracing type （ n = 1,3.1% ） and mixture type （ n = 22,68. 8% ）. Conclusion Transgastric peritoneoscopy via NOTES with histological examination of biopsies has important value in the pathologic diagnosis and the endoscopic typing of peritoneal carcinomatosis.