Department of Surgery, Korea University College of Medicine, Korea University Guro Hospital, 80, Gurodong, Guro-gu, Seoul, Republic of Korea.
World J Surg. 2011 Nov;35(11):2369-75. doi: 10.1007/s00268-011-1224-2.
Despite recent progress, the fast and accurate diagnosis of tuberculous peritonitis (TBP) continues to be a challenge, mainly because of the lack of specific clinical features and the difficulty in isolating the M. tuberculosis. The present study aimed to investigate the role of laparoscopy in the diagnosis of TBP, compared to noninvasive tests.
We retrospectively studied 60 patients who had diagnostic laparoscopy for suspected TBP between January 2002 and June 2010.
Forty-one patients were diagnosed with TBP. In terms of accuracy and predictive value, the visual diagnosis via laparoscope was the most diagnostic test. In the noninvasive tests, both the ascitic adenosine deaminase (ADA) level over 30 U/l, and the ascitic lactate dehydrogenase (LDH) level over 90 U/l had relatively high positive, as well as negative, predictive values. The overall morbidity and mortality rates for laparoscopy were 5 and 5%, respectively.
Laparoscopy is a rapid and accurate diagnostic test for TBP. However, complications may occur. In older patients with associated conditions, a combination of various noninvasive tests and empirical treatments is needed prior to laparoscopy.
尽管最近取得了进展，但快速准确地诊断结核性腹膜炎（TBP）仍然是一个挑战，主要是因为缺乏特异性的临床特征和难以分离结核分枝杆菌。本研究旨在探讨与非侵入性检查相比，腹腔镜检查在 TBP 诊断中的作用。
我们回顾性研究了 2002 年 1 月至 2010 年 6 月间因疑似 TBP 而行诊断性腹腔镜检查的 60 例患者。
41 例患者被诊断为 TBP。在准确性和预测值方面，腹腔镜下的直观诊断是最具诊断价值的检查。在非侵入性检查中，腹水腺苷脱氨酶（ADA）水平超过 30 U/L 和腹水乳酸脱氢酶（LDH）水平超过 90 U/L 的阳性预测值和阴性预测值均较高。腹腔镜检查的总发病率和死亡率分别为 5%和 5%。
腹腔镜检查是一种快速准确的 TBP 诊断方法。但可能会发生并发症。对于伴有合并症的老年患者，在进行腹腔镜检查之前，需要结合各种非侵入性检查和经验性治疗。
