对200例不明原因腹腔积液患者腹膜活检的临床分析

Clinical analysis of Percutaneous Peritoneal biopsy in the diagnosis of 200 patieuts with unexplained ascites

目的探讨超声引导下腹膜穿刺活检对不明原因腹腔积液患者的临床诊断价值。方法选取我院近5年来资料完整的不明原因腹腔积液患者207例，行腹膜活检者200例，总体腹膜活检率为96．6％。其中女117例，年龄17～81岁，平均（58．6±21．7）岁。男83例，年龄20—83岁，平均年龄（53．4±23．1）岁。均经超声、CT和（或）MRI、各种生化和腹腔积液细胞学检查无法确定病因，200例超声或CT所见：大网膜和（或）腹膜局限性弥漫性增厚，厚度6．5～29mm，其中78例见实质性不规则团块，肿块与腹膜分界不清。应用穿刺活检针对上述患者行超声引导经皮腹膜穿刺活检，标本送病理检查，必要时行免疫组化进一步确诊。结果200例患者均一次穿刺取材成功，经病理证实结核性腹膜炎77例（占38．5％），腹膜间皮瘤63例（占31．5％，其中3例重复穿刺取材确诊）、转移性腺癌49例（占24．5％），淋巴瘤1例、腹膜假黏液腺瘤4例、未见明显异常（可见纤维脂肪组织）6例（占3．0％）。一次穿刺活检成功率为100．0％，经腹膜活检明确腹腔积液病因的诊断率为97．0％（194／200）。无严重并发症发生。结论超声引导下经皮穿刺腹膜活检对不明原因腹腔积液的诊断、良恶性腹腔积液的鉴别，特别是对腹膜问皮瘤、转移癌和结核性腹膜炎的鉴别诊断具有重要价值，是一种并发症少而诊断准确率高的有效方法，并能为临床治疗提供病理学依据。

Objective To evaluate the clinical value and safety of ultrasound guided percutaneous peritoneal biopsy in patients with unexplained ascetics. Methods 207 cases clinically considered difficult diagnostic ascetics were analyzed in this study, in which 200 cases were biopsied with automatic spring biopsy needles, with the biopsied patients accounting for 96.6%. Among biopsied patients, there were 117 females, aged 17-81 years （average age 58.6 ±21.7）,and 83 males, aged 20-83 years （average age 53.4 ±23.1）. The causes for all the ascetics could not be identified by image study （ultrasound, CT and or MRI）, or by cytologic study. For all the 200 patients, image study showed diffuse or focal thickening （6.5-29 ram） in peritonea and/or omentum. There were 78 cases in which irregularly parenchymal mass were found, which had no well-defined bounds with omentum. The patients were biopsied for pathological study and, in some cases, immunohisto- chemical examination was performed if indicated. Results Tissues of peritoneal peritoneum were obtained from each of the 200 cases of patients by one-off puncture. In total patients, there were tuberculous peritonitis （n=77, 38.5%）, malignant peritoneal mesothelioma （n=63, 31.5%）, metastatic adenoearcinoma （n=49, 24.5%）,malignant lymphoma （n=l） and peritoneal pseudo-myxadenoma （n=l）. no abnomity was tbund in 6 cases （n=6, 3% ）. one-off biopsy success rate was 100% and 97% of the cases were correctly diagnosed without the presence of serious complications. Conclusion Percutaneous peritoneal biopsy with ultrasound guidance is valuable in the diagnosis of difficult diagnostic ascetics, especially in the differential diagnosis of malignant peritoneal mesothelioma, metastatic carcinoma and tuberculous peritonitis. The study showed that this method is highly accurate in the diagnosis of unexplained ascetics with less complication and offers pathological evidence for clinical therapy.