电子胃镜在疑难腹水诊断中的临床应用价值

Clinical value of electronic gastroscope in difficult diagnosis of ascites

摘要:

目的 探索胃镜在疑难腹水病因诊断中的可行性。 方法 选择脐旁左下2 cm为穿刺点，局部浸润麻醉，皮肤做小切口，建立人工气腹，插入trocar，经trocar导入严格消毒胃镜，按照右上、左上、右下、左下顺序观察，发现病灶，插入活检钳取活检；对腹壁出血灶可予射频直接点灼止血，对腹腔内粘连带也可予射频灼断。 结果 110例疑难腹水，104例获得了阳性结果，阳性率94.5%，其中结核性腹膜炎75例（72%），转移性腹膜癌15例（14.4%），恶性淋巴瘤4例（3.8%），卵巢癌并腹水3例，肝癌并腹膜转移3例，其他病变4例，6例脏、壁层腹膜未见异常。不良反应：该组110例胃镜代腹腔镜检查，3例术后轻度发热，1例由于严重粘连引起肠穿孔。 结论 电子胃镜诊断疑难腹水安全、可靠、操作简单、并发症少，值得推广应用。

Abstract:

【Objective】 To explore the feasibility of endoscopy in etiological diagnosis of difficult in ascites. 【Methods】 The protocol went as following: paraumbilical left 2 cm puncture, local infiltration anesthesia small incision, skin, artificial pneumoperitoneum, insert the trocar, through trocar into strict disinfection of gastroscope, according to the right, left, right, left lower sequential observation, lesions finding, biopsy forceps biopsy of insertion; abdominal hemorrhage may be RF direct burning of hemostasis, intraperitoneal adhesion belt can be RF burning off. 【Results】 In 110 patients with refractory ascites, 104 cases achieved positive results, the positive rate was 94.5%, of which 75 cases of tuberculous peritonitis (72%), peritoneal metastatic carcinoma in 15 cases (14.4%), 4 cases of malignant lymphoma (3.8%), 3 cases of ovarian carcinoma and ascites, liver and peritoneal metastasis in 3 cases, 4 cases of other diseases, 6 cases of visceral, parietal peritoneum were not abnormal. Adverse reaction: this group of 110 cases on behalf of laparoscopy, 3 cases of mild postoperative fever, 1 case of severe adhesion caused by intestinal perforation. 【Conclusion】 Electronic gastroscope diagnosis of ascites with safe, reliable, simple operation, less complications, is worthy of popularization and application.