常规检查对疑难腹水的诊断价值

Diagnostic value of routine examinations in complicated ascites

目的 腹腔镜技术的发展为疑难腹水的诊断提供了手段,但该技术为有创性,其临床价值受到限制.我们对我院近8年经腹腔镜明确诊断的94例疑难腹水患者的各项常规检查结果进行分析,并总结其在疑难腹水诊断中的价值.方法 收集我院自2005年2月～2013年5月经腹腔镜和病理检查明确诊断的疑难腹水患者94例的临床资料,分析其常规检查的特点,探讨常规检查在疑难腹水诊断中的价值.结果 单纯症状学差异在鉴别结核和肿瘤所致腹水中的作用不大.肿瘤患者腹水中间皮细胞比例〉10%及乳酸脱氢酶明显升高较结核更常见;多种肿瘤标记物的升高较单一指标升高对肿瘤的诊断意义较结核大;腹水腺苷脱氨酶升高对诊断结核有临床意义;影像学CT或MRI检查无特异性;静脉血干扰素-γ的阴性结果有助于排除结核的诊断.结论腹腔镜检查在疑难腹水的诊断中有非常重要的作用,但是常规检查仍然有着不可替代的价值,其结果应受到临床医师的足够重视.

Objective Although laparoscopic technique provides powerful method for diagnosing complicated ascites, its clinic value is limited because of its invasiveness. This study retrospectively evalu- ated the diagnostic value of routine examinations in 94 cases diagnosed by laparoscope in our hospital in recent 8 years. Methods Ninety-four cases with complicated ascites diagnosed by clinical laparoscope and pathological examinations were recruited to analyze the features of routine examinations from February 2005 to May 2013. Results It is much difficult to differentiate tuberculosis （TB） from tumors just through the symptoms. Both TB and tumor showed the elevation of platelet （PLT） and fibrinogen （ FIB ）. The ratio of mesothelium cells（ 〉 10% ） and the value of lactate dehydrogenase（LDH） in ascites often in- creased in malignant than in TB. The tumor markers, such as carcino-embryonic antigen （CEA） , carbohy- drate Antigen 19-9 （ CA19-9）, carbohydrate antigen 125 （ CA-125）, often showed 10 times higher than nor- mal in malignant ascites. Adenosine deaminase（ADA） （ 〉 40 u/L） had clinical significance in diagnosing TB. CT or MRI had no diagnostic specificity. Negative result of serum interferon-γ（IFN-γ） was useful for excluding the diagnosis of TB. Conclusion Routine examinations remain the values in diagnosing compli- cated ascites.