腹腔内镜检查及直视下取检对疑难性肝病的诊断价值

Diagnostic value of laparoscopy and under direct vision for difficult liver diseases

目的探讨腹腔内镜检查及直视下取活检对疑难性肝病的诊断价值。方法对35例临床诊断不明的疑难性肝病患者进行腹腔内镜检查并行腹腔内镜直视下取活检。结果经腹腔内镜检查及直视下取活检确诊34例,确诊率为97.14%。其中17例肝脏占位性病变中确诊为原发性肝癌9例、转移性肝癌2例、肝硬化结节3例、肝局灶结节性增生2例、肝血管瘤1例;18例肝功能异常者确诊为早期肝硬化6例、隐匿性乙型病毒性肝炎3例、脂肪肝3例、结核性腹膜炎并肝结核2例、Gilbert综合征2例、原发性胆汁性肝硬化1例,1例未能确诊。部分肝脏疾病在内镜下有特征性表现,所有患者无严重并发症发生。结论腹腔内镜检查微创、直观,直视下取活检敏感性高、并发症少,其用于诊断疑难性肝病是一种安全有效的诊断方法。

Objective To investigate the value of laparoscopy test and under direct vision biopsy in the diagnosis of difficult liver diseases. Methods Thirty-five patients with chronic liver diseases with unknown diagnosis were examined by endoscopy and laparoscopy under direct vision. Results Thirty-four cases were diagnosed by endoscopy and laparos- copy under direct vision. The diagnosis rate was about 97.14%. Seventeen cases of liver lesions were diagnosed as 9 cases of primary liver cancer, 2 cases of metastatic liver carcinoma, 3 cases of liver cirrhosis, 2 cases of hepatic focal nodular hyperplasia, 1 case of hepatic hemangioma; 18 cases of abnormal liver function were diagnosed as 6 cases of early cirrhosis, 3 cases of occult hepatitis B, 3 cases of fatty liver, 2 cases of tuberculous peritonitis and hepatic tuber- culosis and 2 cases of Gilbert syndrome, 1 case of primary biliary cirrhosis, 1 case undiagnosed. Some liver diseases were characterized by endoscopy, and no serious complications occurred in all patients. Conclusion It is a safe and ef- fective method for the diagnosis of difficult liver diseases, which has the advantages of minimal invasive surgery, high sensitivity and less complications.