诊断性腹腔镜的临床应用研究

Clinical Study of Diagnostic Laparoscopy

目的:评价诊断性腹腔镜的检查方法、效果及安全性,提高腹部疑难疾病的早期诊断率。方法:回顾分析58例腹部疑难疾病患者的腹腔镜检查情况,其中腹水原因待查35例,腹水+腹部包块23例。结果:58例患者中诊断为结核性腹膜炎31例,恶性腹膜间皮瘤23例,腹膜转移癌2例,盆腔结核及慢性盆腔炎各1例。不同疾病在腹腔镜下有不同表现。操作时间25-70min,平均38min。并发症为活检处出血4例,其中3例为自限性出血,1例经局部喷洒凝血酶后停止,术后伤口漏水5例。对腹腔镜下有肯定判断的12例患者同时进行治疗。结论:腹腔镜检查具有安全、简便、微创、痛苦小、确诊率高等优点。诊断性腹腔镜值得进一步推广应用。

Purpose: To evaluate the operational method, effect and security of diabnostic laparoscopy, and to improve the early diagnosis of complicated celiac diseases. Methods: A retrospective analysis was performed on 58 patients who underwent laparoscopy between 1995 and 2002, of all patients, 35 with ascites of unknown origin,23 with ascites and celiac masses. Results: Of 58 patients, 31 were diagnosed as tuberculous peritonitis, 23 were malignant peritoneal mesothelioma, 2 were peritoneum petastatic carcinoma, 1 was tuberculous pelviperitonitis and 1 was chronic pelviperitonitis. Different visualization at laparoscopy was observed in different diseases. The operational time was 25-70 minutes, and the average time was 38 minutes. The complication was bleeding at the biopsy site in 4 patients. In the majority of cases, bleeding was self- limiting(3/4.75%), the other one could be controlled with thrombin sprayed on the biopsy site. 5 were aleak from the wounds after operation. Proper therapies were performed in 12 patients with affirmative diagnosis. Conclusion: Laparoscopy combines the advantages of safeness, little wound, less hurt and suffering, simplicity and high diagnostic rate. Diagnostic laparoscopy is worth to be popularized.