Chu C M, Lin S M, Peng S M, Wu C S, Liaw Y F
Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Gastrointest Endosc. 1994 May-Jun;40(3):285-9. doi: 10.1016/s0016-5107(94)70057-5.
The role of laparoscopy in the diagnostic evaluation of ascites of unknown origin was studied in 129 patients. Laparoscopic results were as follows: (1) Carcinomatosis peritonei in 78 (60.5%). Peritoneal biopsies in 76 of these cases revealed malignancy in 67 (adenocarcinoma 62, lymphoma 4, mesothelioma 1) and tuberculosis in 5; specimens were inadequate for diagnosis in 4. (2) Tuberculous peritonitis in 26 (20.2%). Peritoneal biopsies in 24 of these cases revealed tuberculosis in 22 and non-specific chronic peritonitis in 2. (3) Cirrhosis in 7 (5.4%). (4) No gross abnormality in 18 (14.0%). Of the latter, causes of ascites had already been identified in 13 (72.2%), including chronic renal failure in 7, systemic lupus erythematosus in 2, constrictive pericarditis in 2, chronic pancreatitis with chylous ascites in 1, and retroperitoneal lymph node metastasis with chylous ascites in 1. Thus, laparoscopic observation in combination with biopsy established the cause of ascites of unknown origin in 111 (86.0%) of 129 patients. Most of the 18 patients without gross laparoscopic abnormality had underlying disease identified as a cause of ascites; laparoscopy was indicated in these cases to exclude other processes that may also cause ascites.
对129例不明原因腹水患者进行了腹腔镜检查在诊断评估中的作用研究。腹腔镜检查结果如下：（1）腹膜癌病78例（60.5%）。其中76例腹膜活检显示67例为恶性（腺癌62例、淋巴瘤4例、间皮瘤1例），5例为结核；4例标本诊断不充分。（2）结核性腹膜炎26例（20.2%）。其中24例腹膜活检显示22例为结核，2例为非特异性慢性腹膜炎。（3）肝硬化7例（5.4%）。（4）18例（14.0%）无明显异常。在后者中，13例（72.2%）已确定腹水病因，包括慢性肾衰竭7例、系统性红斑狼疮2例、缩窄性心包炎2例、慢性胰腺炎伴乳糜性腹水1例、腹膜后淋巴结转移伴乳糜性腹水1例。因此，腹腔镜检查结合活检确定了129例患者中111例（86.0%）不明原因腹水的病因。18例腹腔镜检查无明显异常的患者中，大多数有潜在疾病被确定为腹水病因；在这些病例中进行腹腔镜检查是为了排除其他可能导致腹水的疾病。
