腔镜下腹腔淋巴结活检在疾病诊断中的临床应用

Clinical application of laparoscopic celiac lymph node biopsy in disease diagnosis

目的：探讨腹腔镜活检在不明原因腹腔淋巴结肿大疾病中的诊断价值。方法：2007年9月至2010年12月为23例临床难以诊断的腹腔淋巴结肿大患者通过腹腔镜检查及活检进行分析诊断,其中男13例,女10例;平均（43.6±21.4）岁。结果：23例分别取出1-4枚0.7-3.0 cm大的淋巴结,病理结果为炎症性淋巴结肿大10例,腹腔、肠系膜淋巴结结核6例,淋巴瘤5例,转移性肿瘤1例,无明确诊断1例。手术时间平均（73.2±47.8）min,术中出血量平均（34.6±11.5）ml,无中转开腹。术后平均住院（3.2±1.7）d。术后1例出现淋巴漏,未出现与腹腔镜检查直接相关的死亡病例。结论：腹腔镜淋巴结活检术具有患者创伤小、安全性高及患者康复快等优点,为不明原因的腹腔内淋巴结肿大提供了安全、有效的诊断手段;尤其对于非特异性淋巴结炎、腹腔淋巴结结核、淋巴瘤、转移性肿瘤等疾病诊断、鉴别困难时,腹腔镜检查、活检可提供正确的诊断,减少误诊。

Objective： This study is aimed to investigate the diagnosis value of laparoscopic biopsy of celiac lymph node for lymph node enlargement with unknown reason. Methods： Between Sep. 2007 and Dec. 2010,twenty-three patients who suffered from celiac lymph node enlargement with unknown reason underwent laparoscopy and lymph node biopsy. The patients included 13 males and10 females with the average age of（ 43. 6 ± 21. 4） years. Results： A total of 23 patients were dissected 1-4 lymph nodes per patient and the size of lymph nodes ranged from 0. 7 to 3. 0 cm. The histological results were as follows： 10 cases were diagnosed as lymphadenitis,6 cases were celiac or mesentery lymphoid tuberculosis,5 cases were lymph adenoma,1 case was metastatic tumor and result of 1 case was indefinite. The average operative time was（ 73. 2 ± 47. 8） min,and the average intraoperative blood loss was（ 34. 6 ± 11. 5） ml,no cases were converted to laparotomy. The average hospital stay after operation was（ 3. 2 ± 1. 7） d. 1 case of postoperative lymphatic fistula occurred and no death directly related to the laparoscopic procedure was found. Conclusions： With such advantages as minor trauma,high security and quick recovery,laparoscopic lymph node biopsy provides a safe and effective tool to diagnose celiac lymph node enlargement with unknown reason. Laparoscopy and biopsy can provide correct diagnosis and reduce the misdiagnosis,especially for nonspecific lymphadenitis,celiac lymph tuberculosis,lymphadenoma and metastatic tumor which are difficult to be diagnosed and discriminated.