腹腔镜和经胃的自然腔道内镜手术在不明原因腹水诊断中的临床应用比较

发布时间：2018-04-17 04:09

本文选题：腹腔镜 + 自然腔道内镜手术　；参考：《中国内镜杂志》2017年01期

【摘要】：目的总结经腹腔镜和经胃的自然腔道内镜手术(NOTES)行腹腔探查及腹膜活检在不明原因腹水的临床应用体会。方法回顾性分析该科2014年1月-2015年10月,20例经腹腔镜和2015年5月-2016年7月经胃NOTES检查11例不明原因腹水的临床资料,并对两组手术的手术时间、住院费用、住院时间、术中出血、术后腹痛评分、术后3天白细胞和发热进行比较。结果腹腔镜检查组20例,11例诊断为结核性腹水,8例诊断为癌性腹水,1例诊断不明;NOTES检查组9例诊断为结核性腹水,1例诊断为癌性腹水,1例诊断为肝硬化腹水。两组诊断明确30例(96.8%),结核性腹水20例(64.5%),癌性腹水9例(29.0%)。腹腔镜组与NOTES组比较:手术时间长、住院费用高,差异有统计学意义(P0.05);术后住院时间长,差异有统计学意义(P0.05);术中出血、术后腹痛评分、术后3天白细胞和发热差异无统计学意义(P0.05)。结论两种检查方法均能快速准确地诊断腹水原因,以利于治疗,且手术创伤小,严重并发症少。但经胃NOTES较经腹腔镜更具有优势。
[Abstract]:Objective to summarize the clinical application of laparoscopy and endoscopic endoscopy (NOTES) for peritoneal exploration and peritoneal biopsy in patients with unexplained ascites.Methods from January 2014 to October 2015, the clinical data of 20 patients with unexplained ascites examined by laparoscopy and gastric NOTES from May 2015 to July 2016 were analyzed retrospectively. The operation time, hospitalization cost and hospitalization time of the two groups were analyzed.Intraoperative bleeding, postoperative abdominal pain score, 3 days after the white blood cell and fever were compared.Results in 20 cases of laparoscopic inspection, 11 cases were diagnosed as tuberculous ascites, 8 cases were diagnosed as malignant ascites, 1 case was diagnosed as tuberculous ascites, 1 case was diagnosed as cirrhosis ascites, 1 case was diagnosed as tuberculous ascites in 9 cases.There were 30 cases with tuberculous ascites, 20 cases with tuberculous ascites, and 9 cases with cancerous ascites.Compared with NOTES group, laparoscopy group had longer operation time and higher hospitalization cost, the difference was statistically significant (P 0.05), postoperative hospitalization time was longer, the difference was statistically significant (P 0.05), intraoperative hemorrhage, postoperative abdominal pain score,There was no significant difference in leukocyte and fever 3 days after operation (P 0.05).Conclusion both methods can quickly and accurately diagnose the cause of ascites, which is beneficial to the treatment, with less surgical trauma and less serious complications.But transgastric NOTES has more advantages than laparoscopy.
【作者单位】：重庆市涪陵中心医院消化内科;
【分类号】：R57

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