腹腔镜对原因不明的女性腹水患者的诊断意义

The significance of diagnostic laparoscopy in women with unknown origin ascites

目的腹水是临床疾病中常见的体征,有时很难判断出其病因。文中研究腹腔镜探查在无明显内、外科疾病,经腹水穿刺检查阴性的女性腹水患者诊断及治疗中的意义。方法收集2002年1月至2012年1月我科收治的无明确内、外科疾病,腹水穿刺检查阴性的33例女性患者进行腹腔镜检查,整理分析临床及手术病理资料,并进行随访。结果经腹腔镜探查后,29例明确诊断,其中结核性腹水23例,黏液性卵巢癌3例,腹膜原发癌3例;1例乳糜腹水者经淋巴结活检后确诊为淋巴瘤。另3例腹腔镜检查未见异常,其中1例因免疫检查异常按自身免疫性疾病治疗后好转;1例甲状腺功能低下,经补充甲状腺素治疗后好转;1例行PET/CT提示右卵巢代谢增高,再次手术切除右卵巢,病理提示为子宫内膜异位症、多发性囊状滤泡及囊状黄体增生伴出血,术后腹水及症状渐好转。结论对反复内、外科检查仍原因不明的女性腹水患者,腹腔镜探查有利于快速准确地诊断疾病,以利于治疗。

Objective Ascites is a common sign in the clinical practice, but the identification of etiological factors sometimes are difficult. This study aimed to investigate the diagnostic and therapeutic significance of laparoscopy in women with ascites. Methods Thirty three female patients with ascites, and without significant medical or chirurgie diseases or positive results in the examination of paracentesis abdominis, were recruited from January 2002 to January 2012. Clinical features, pathological findings and the results of fol- low-up were collected and analyzed retrospectively. Results Twenty-nine patients obtained definite diagnosis after laparoscopic exami- nation, including twenty three peritoneal tuberculosis, three mucinous epithelial ovarian cancers and three primary peritoneal carcinomas. One patient with chylus ascites was diagnosed as lymphoma after lymphonodus biopsy. There were no positive findings in other three pa- tients after laparoscopic examination, in which one was found abnormal auto-antibody and got remission after anti-antoimmune therapy; another one was found hypothyroid and got remission after oral thyroxine; PET/CT scan showed abnormal fluorodeoxyglucose metabolism in the right ovary in the third patient. Right oophorectomy was performed and pathologic diagnosis showed endometriosis, polycystic ovary and luteoma, and the ascites and clinical symptom were improved after the surgery. Conclusion Laparoscopy is an useful technique to make a quick and accurate diagnosis and to adopt an effective treatment for women with unknown origin ascites.