NOTES经胃入路诊断不明原因腹水的临床研究

Clinical research of transgastric approach transluminal endoscopic surgery in diagnosing unexplained ascites

目的探讨经自然腔道内镜外科(NOTES)经胃入路对不明原因腹水的病因诊断的临床价值。方法回顾该院2015年11月至2016年7月采用经胃入路NOTES诊断12例不明原因腹水患者进行腹腔探查及腹膜活检的临床资料,通过对术后有无并发症发生及疾病诊断率进行分析统计,评估该手术风险及临床应用价值。结果通过腹腔探查、腹膜活检后病理学证实,确诊率达100%,其中结核性腹膜炎8例(66.7%)、肝硬化2例(16.7%)、腹膜间皮瘤1例(8.3%)、转移性腹膜癌1例(8.3%);术后出现腹痛2例,其中1例中性粒细胞比值升高,症状及实验室指标异常持续时间均未超过24h,发生率为8.3%;无术后腹腔感染、切口出血、穿刺口瘘等并发症发生。结论 NOTES经胃入路腹腔探查及腹膜活检诊断不明原因腹水,具有创伤小、并发症少、术后恢复快等优势,具有重要的临床应用价值。

Objective To explore the clinical value of transgastric natural orifice transluminal endoscopic surgery（NOTES）in diagnosing unexplained ascites.Methods The clinical data in 12 cases of unexplained ascites diagnosed by adopting transgastric approach NOTES and performed abdominal exploration and peritoneal biopsy in our hospital from November 2015 to July 2016 were retrospectively analyzed.The operative risk and clinical application value were evaluated by statistically analyzing the postoperative complications occurrence and the diagnosis rate of disease.Results The definite diagnosis rate reached 100% verified by pathology after abdominal exploration and peritoneal biopsy,in which 8cases（66.7%）were tuberculous peritonitis,2cases（16.7%）were liver cirrhosis,1case（8.3%）was peritoneal mesothelioma,1cases（8.3%）was peritoneal metastatic carcinoma;2cases appeared abdominal pain after operation,including 1case of neutrophil ratio increase,symptoms and persistent time of abnormal laboratory indexes did not exceed 24 h,the incidence rate was 8.3%;no complications of abdominal cavity infection,incision bleeding and puncture site fistula occurred.Conclusion The transgastric NOTES for conducting abdominal exploration and peritoneal biopsy in the diagnosis of unexplained ascites has the advantages of small trauma,less complications and rapid postoperative recovery,possesses an important clinical application value.