腹腔镜和经胃的自然腔道内镜手术在不明原因腹水诊断中的临床应用比较

Comparison of laparoscopic and NOTES operation applied in diagnosis of unexplained ascites

摘要:

目的??总结经腹腔镜和经胃的自然腔道内镜手术（NOTES）行腹腔探查及腹膜活检在不明原因腹水的临床应用体会。方法?回顾性分析该科2014年1月-2015年10月，20例经腹腔镜和2015年5月-2016年7月经胃NOTES检查11例不明原因腹水的临床资料，并对两组手术的手术时间、住院费用、住院时间、术中出血、术后腹痛评分、术后3天白细胞和发热进行比较。结果?腹腔镜检查组20例，11例诊断为结核性腹水，8例诊断为癌性腹水，1例诊断不明；NOTES检查组9例诊断为结核性腹水，1例诊断为癌性腹水，1例诊断为肝硬化腹水。两组诊断明确30例（96.8%），结核性腹水20例（64.5%），癌性腹水9例（29.0%）。腹腔镜组与NOTES组比较：手术时间长、住院费用高，差异有统计学意义（P <0.05）；术后住院时间长，差异有统计学意义（P <0.05）；术中出血、术后腹痛评分、术后3天白细胞和发热差异无统计学意义（P >0.05）。结论?两种检查方法均能快速准确地诊断腹水原因，以利于治疗，且手术创伤小，严重并发症少。但经胃NOTES较经腹腔镜更具有优势。

Abstract:

Objective?To summarize the stomach via laparoscopic and natural orifice transluminal endoscopic surgery (NOTES) Clinical application of abdominal exploration and peritoneal biopsy unexplained ascites. ?Methods?A retrospective analysis of our hospital clinical datum of unexplained ascites patients, 20 cases were undergone single port laparoscopic operation from January 2014 to October 2015 and 11 cases were undergone NOTES from May 2015 to July 2016. Operation time, hospitalization expenses, intraoperative bleeding, postoperative hospital stay, postoperative abdominal pain score, fever and leukocyte on the 3rd postoperation were compared in tow groups.?Results?Laparoscopy group 20 cases, 11 cases diagnosed as tuberculous ascites, 8 cases malignant ascites, 1 case was still unknown; NOTES group 11 cases, 9 cases diagnosed as tuberculous ascites, 1 case malignant ascites and 1 case liver cirrhosis. In two groups, 30 cases were accurate diagnosed (96.8%), tuberculous ascites 20 cases (64.5%), malignant ascites nine cases (29.0%). Laparoscopy group compared with NOTES group, operation time was longer and hospitalization expenses was more, there were statistical significant differences (P < 0.05); postoperative hospital stays were higher (P < 0.05); intraoperative bleeding, postoperative abdominal pain score, fever and leukocyte on the 3rd postoperation were no statistical difference (P > 0.05).?Conclusion?The two methods were able to quickly and accurately diagnose ascites reason, in order to facilitate treatment and surgical trauma, less serious complications. Comparison of laparoscopy, NOTES may be more advantageous in ascites diagnosis.