Allah Maha Hasab, Salama Zakaria A, El-Hindawy Aly, Al Kady Nabil
Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Arab J Gastroenterol. 2012 Sep;13(3):116-24. doi: 10.1016/j.ajg.2012.08.004. Epub 2012 Sep 14.
Ascites may be of undetermined origin despite comprehensive study. This study aimed to assess the accuracy and safety of conventional and interventional high-frequency peritoneal ultrasound in the diagnosis of patients with ascites of unclear origin.
A total of 62 patients were prospectively enrolled; they underwent conventional (3.5-5MHz) and high-frequency (6-8MHz) transabdominal peritoneal ultrasound to suggest the nature of ascites supplemented by fine needle aspiration cytology (FNAC) of ascites and/or core biopsy of the omentum or other extra-visceral masses for final histopathologic diagnosis. Laparoscopy or laparotomy was needed if biopsy was inconclusive.
Ultrasound-guided procedures were diagnostic in 55 (87.7%) patients. Thirty-six (58.1%) were benign, of whom 86% had tuberculous peritonitis, 26 (41.9%) were malignant, of whom 76.9% had peritoneal metastasis. High-frequency ultrasound was able to propose ultrasonographic criteria in a trial to diagnose the nature of ascites. Our proposed ultrasonographic criteria were based on the amount and texture of ascites in addition to the omental and mesenteric features. These were able to suggest the diagnosis with 80.7% sensitivity for malignant ascites and 75% specificity for benign ascites. Moreover, histopathological examination of tissues obtained by ultrasound-guided procedures increased the sensitivity to 88.5% and the specificity to 88.9% in diagnosing malignant and benign disease, respectively, with an overall diagnostic accuracy of 88.6%. These procedures were considered to be safe as only one major (haemoperitoneum) and two minor complications (temporary ascitic fistula) were reported.
High-frequency peritoneal ultrasound together with the minimally invasive ultrasound-guided FNAC/biopsy of extra-visceral lesions may be considered an effective and safe tool in the diagnosis of ascites of undetermined origin.
尽管进行了全面检查，腹水的病因仍可能不明。本研究旨在评估传统及介入性高频腹膜超声诊断不明原因腹水患者的准确性及安全性。
前瞻性纳入62例患者；对其进行传统（3.5 - 5MHz）及高频（6 - 8MHz）经腹腹膜超声检查，以判断腹水性质，并辅以腹水细针穿刺细胞学检查（FNAC）及大网膜或其他脏外肿物的核心活检以进行最终组织病理学诊断。若活检结果不明确，则需进行腹腔镜检查或剖腹手术。
超声引导下操作对55例（87.7%）患者具有诊断价值。36例（58.1%）为良性，其中86%患有结核性腹膜炎；26例（41.9%）为恶性，其中76.9%患有腹膜转移瘤。高频超声能够在判断腹水性质的试验中提出超声诊断标准。我们提出的超声诊断标准基于腹水的量和质地以及大网膜和肠系膜特征。这些标准对恶性腹水的诊断敏感性为80.7%，对良性腹水的诊断特异性为75%。此外，对超声引导下获取的组织进行组织病理学检查，在诊断恶性和良性疾病时，敏感性分别提高到88.5%，特异性提高到88.9%，总体诊断准确率为88.6%。这些操作被认为是安全的，仅报告了1例严重并发症（腹腔积血）和2例轻微并发症（暂时性腹水瘘）。
高频腹膜超声联合微创超声引导下对脏外病变进行FNAC/活检，可被视为诊断不明原因腹水的有效且安全的工具。
