[1]张剑,李临海,龚昆梅,等.425局麻下腹腔镜检查对不明原因腹水的诊断价值（附46例报告）[J].中国微创外科杂志,2012,12(5):429-433.
　Zhang Jian,Li Linhai,Gong Kunmei,et al.Laparoscopic Diagnosis of Unexplained Ascites under Local Anesthesia: Report of 46 Cases[J].Chinese Journal of Minimally Invasive Surgery,2012,12(5):429-433.
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425局麻下腹腔镜检查对不明原因腹水的诊断价值（附46例报告）()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
12
期数:
2012年5期
页码:
429-433
栏目:
出版日期:
2012-05-25

文章信息/Info

Title:
Laparoscopic Diagnosis of Unexplained Ascites under Local Anesthesia: Report of 46 Cases
作者:
张剑; 李临海; 龚昆梅; 王昆华;  肖乐
云南省第一人民医院普外科云南省肠内及肠外营养研究中心，昆明650034
Author(s):
Zhang Jian;  Li Linhai;  Gong Kunmei;  et al.
Department of General Surgery, First People’s Hospital of Yunnan Province, Research Center for Enteral and Parenteral Nutrition of Yunnan Province, Kunming 650034, China
关键词:
腹腔镜; 腹水
Keywords:
Laparoscopy; Ascites
分类号:
R656.04
文献标志码:
A
摘要:
目的探讨腹腔镜探查对不明原因腹水的诊断价值。方法2007年11月~2010年11月46例不明原因腹水局麻下行腹腔镜探查术。1%利多卡因5 ml局麻，选择脐部或需要穿刺的部位作为穿刺点，做10 mm或5 mm切口，建立CO2气腹（压力<8 mm Hg），置入腹腔镜，根据镜下所见做切口置入5 mm trocar,根据腹水量和操作需要缓慢放腹水500~2000 ml，然后腹腔探查，取材。结果1例因腹腔内粘连严重腹腔镜探查未成功。活检阳性43例，阳性率95.6%（43/45)，其中结核性腹膜炎37例(86.0%，37/43)，转移性腺癌3例(7.0%，3/43)，腹膜间皮瘤1例(2.3%，1/43)，卵巢外腹膜浆液性乳头状癌1例(2.3%，1/43)，淋巴瘤1例(2.3%，1/43)；未明确诊断3例，阴性率（3/46，6.5%)。所有病人均未发生并发症。结论不明原因腹水患者病因以结核性腹膜炎及恶性肿瘤为主，局麻下腹腔镜检查对不明原因腹水诊断安全有效。
Abstract:
ObjectiveTo investigate the value of laparoscopic diagnosis for ascites with uncertain causes.MethodsWe retrospectively analyzed the clinical data of 46 patients with unexplained ascites, who were diagnosed with laparoscopy under local anesthesia from November 2007 to November 2010. With lidocaine (1%, 5 ml) for local anesthesia, at the umbilicus or other puncture sites, we made a 5 to 10mm incision so that to establish CO2 pneumoperitoneum (<8 mm Hg), and then inserted a 5mm trocar to drain ascites (500-2000 ml, based on the total volume of the ascites). Afterwards, we explored the abdominal cavity and obtained samples for pathological examination.ResultsIn the 46 cases, laparoscopic diagnosis was failed in one case because of serve abdominal adhesion. In the other 45 cases, the positive rate of biopsy was 93.5%［43 cases, including 37 cases of tuberculous ascites (86.0%), 3 cases of metastatic adenocarcinoma (7.0%), 1 case of peritoneal mesothelioma (2.3%), 1 case of papillary serous peritoneal carcinoma (2.3%), and 1 case of lymphoma (2.3%)］. Three patients didn’t get final diagnosis (3/46, 6.9%). No patient developed complications. ConclusionsThe most common causes of unexplained ascites include tuberculous peritonitis and malignant tumors. Laparoscopic diagnosis under local anesthesia is safe and effective for unexplained ascites.

参考文献/References:

[1]Porcel A, Alcaín G,Moreno M, et al. Value of laparoscopy in ascites of undetermined origin. Rev Esp Enferm Dig,1996,88(7):485-489.
[2]Agresta F, Ciardo LF, Mazzarolo G, et al. Peritonitis: laparoscopic approach. World J Emerg Surg, 2006,1:9.
[3]Volpi E, Calgaro M, Ferrero A, et al. Genital and peritoneal tuberculosis:potential role of laparoscopy in diagnosis and management. J Am Assoc Gynecol Laparosc,2004,11(2):269-272.
[4]张澍田，于中麟.腹腔镜诊断价值的再评估.中华消化内镜杂志,2000,17(5):26.
[5]周东雷，郑成竹，胡旭光，等.腹腔镜对不明原因腹水诊断价值研究.中国实用外科杂志, 2007,27(8):627-629.
[6]吴志棉，于俊峰，陈流华，等.腹腔镜探查在不明原因腹水中的应用.中国内镜杂志,2001,7(5):50.
[7]Apaydin B, Paksoy M, Bilir M, et al. Value of diagnostic laparoscopy in tuberculous peritonitis. Eur J Surg,1999,165(2):158-163.
[8]克力木，李梅，张成，等.不明原因肿瘤性腹水腹腔镜探查术的价值探讨.新疆医学,2010,40(5):25-27.
[9]刘晓军，刘彦，金志军，等.腹腔镜在女性不明原因腹水症中的应用.中国实用妇科与产科杂志,2003,19(11): 675-676.
[10]张安田，杜雅菊，高善玲.腹腔镜检查对腹膜病变的诊断价值.中华消化内镜杂志,2002,19(2):92-94.

备注/Memo

备注/Memo:
王昆华通讯作者，Email:llh2011llh@126.com
更新日期/Last Update: 2013-04-03