CAJ | 학술논문

目的探讨经胃的经自然腔道内镜手术(NOTES)腹腔内镜检查对结核性腹膜炎的诊断价值.方法回顾20例经胃NOTES腹腔内镜检查及病理活检确诊为结核性腹膜炎患者的相关临床资料,并进行性分析总结.结果 20例患者经胃NOETS腹腔内镜检查及病理活检后明确诊断为结核性腹膜炎.内镜检查结果为4型:(1)粟粒型:内镜表现为腹水、腹膜散在分布白色粟粒状结节；(2)粘连型:内镜表现腹膜增厚,腹膜与网膜、肠管之间存在不同程度的粘连；(3)干酪型:内镜表现壁层溃疡及淡黄色干酪样物质；(4)混合型:内镜表现为同时存在2种或3种类型.其他各项实验室及特殊检查的阳性例数分别为血红蛋白下降10例,红细胞沉降率增快16例,C反应蛋白升高13例,CA125升高18例,胸片异常8例,腹部彩超异常2例,腹部CT异常7例,结核菌素实验阳性9例,结肠镜检查阳性1例,20例结核抗体、腹水培养、腹水细菌学检查、胃镜检查均阴性.结论经胃NOTES腹腔内镜检查及病理活检是确诊结核性腹膜炎非常有效的诊断方法.
목적 탐토경위적경자연강도내경수술(NOTES)복강내경검사대결핵성복막염적진단개치.방법 회고20례경위NOTES복강내경검사급병리활검학진위결핵성복막염환자적상관림상자료,병진행성분석총결.결과 20례환자경위NOETS복강내경검사급병리활검후명학진단위결핵성복막염.내경검사결과위4형:(1)속립형:내경표현위복수、복막산재분포백색속립상결절；(2)점련형:내경표현복막증후,복막여망막、장관지간존재불동정도적점련；(3)간락형:내경표현벽층궤양급담황색간락양물질；(4)혼합형:내경표현위동시존재2충혹3충류형.기타각항실험실급특수검사적양성례수분별위혈홍단백하강10례,홍세포침강솔증쾌16례,C반응단백승고13례,CA125승고18례,흉편이상8례,복부채초이상2례,복부CT이상7례,결핵균소실험양성9례,결장경검사양성1례,20례결핵항체、복수배양、복수세균학검사、위경검사균음성.결론 경위NOTES복강내경검사급병리활검시학진결핵성복막염비상유효적진단방법.
Objective To investigate the diagnostic value of trans-gastric peritoneoscopy with technique of natural orifice transluminal endoscopic surgery(NOTES)for tuberculosis peritonitis.Methods Clinical data of 20 patients with tuberculosis peritonitis diagnosed by trans-gastric peritoneoscopy via NOTES were retrospectively analyzed.Results All diagnoses were confirmed by biopsy.The findings of peritoneoscopy were defined as miliary type with miliary nodes scattered in ascites and on peritoneum,adhesive type with thickening of peritoneum and adhesion between peritoneum and intestines,cheese-like type with parietal peritoneal ulcer and cheese-like substances,and mixed type with 2 or 3 of above mentioned types.Positive findings in other laboratory examinations were hemoglobin decrease in 10(50％)patients,blood sedimentation rate increase in 16(80％),C reactive protein increase in 13(65％),CA125 increase in 18(90％),and positive tuberculin test in 9(45％).Abnormal findings were detected by chest X-ray in 8(40％)patients,by abdominal ultrasonography examination in 2(10％),by abdominal CT in 7(35％),and by colonoscopy in 1(5％).No abnormal results were found in all patients in anti-tuberculosis antibody test,ascites bacteria culture and gastroscopy.Conclusion Trans-gastric peritoneoscopy via NOTES with biopsy is effective for diagnosis of tuberculosis peritonitis.