非肝源性腹水的病因及诊断分析

发布时间：2018-06-03 09:32

本文选题：腹水 + 病因学　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的分析非肝源性腹水的病因构成,探讨不同诊断方法对非肝源性腹水的诊断价值。方法收集2006年10月至2016年10月宁夏医科大学总医院排除肝源性因素的428例“以腹水原因待查”收住入院患者。根据患者资料分析非肝源性腹水的病因构成。整理并统计患者一般资料(年龄、性别、民族、临床症状、体征等),实验室检查(血沉、C反应蛋白、肿瘤标志物、腹水常规、腹水生化等)、影像学检查(超声、CT、MRI、内镜等)、特殊检查(腹膜活检、腹腔镜等)结果,探讨其对非肝源性腹水的诊断价值。结果1.病因构成:非肝源性腹水病因按比例依次为结核性腹水190例(44.4%)、恶性腹水164例(38.3%)、其他病因腹水74例(17.3%)。2.诊断方法对非肝源性腹水的诊断价值:2.1年龄、性别、民族:恶性腹水平均年龄为56.38±16.04岁、结核性腹水平均年龄为48.20±19.05岁、其他病因腹水平均年龄为43.32±21.47岁,恶性腹水年龄高于结核性腹水(P=0.001,P0.05)及其他病因腹水(P=0.000,P0.05)。恶性腹水好发年龄为40-59岁,结核性腹水、其他病因腹水好发年龄为20-39岁。不同性别、民族非肝源性腹水病因构成无统计学差异(P0.05)。但恶性腹水中,女性以卵巢癌及胃癌多见,男性以胃癌及原发灶不明的腹膜转移癌多见。2.2.实验室检查:结核性腹水中C反应蛋白、腹水腺苷脱氨酶最高,均值分别为38.08±29.66 mg/L、47.94±15.11 U/L;恶性腹水中腹水乳酸脱氢酶最高,均值为335.19±359.82 U/L,且血清及腹水CEA、CA199、CA153、腹水CA125较其他两组明显升高,差异有统计学意义(P0.05)。2.3.腹膜活检、腹腔镜检查:完成腹膜活检54例,最终经组织病理确诊47例,其中结核性腹膜炎31例,恶性肿瘤16例,病因仍不明7例,确诊率87.0%。完成腹腔镜检查14例,最终经组织病理确诊12例,其中结核性腹膜炎7例,恶性肿瘤5例,病因仍不明2例,确诊率85.7%。结论1.本研究中非肝源腹水病因中以结核性腹水最多见,其次为恶性腹水。恶性腹水中女性以卵巢癌及胃癌多见,男性以胃癌及原发灶不明的腹膜转移癌多见。2.恶性腹水发病年龄最高,好发年龄为40-59岁。结核性腹水、其他病因腹水好发年龄为20-39岁。3.C反应蛋白、腹水乳酸脱氢酶、腺苷脱氨酶对非肝源性腹水的病因诊断有一定价值。4.腹水CA125、血清及腹水CEA、CA199、CA153可用于鉴别非肝源性腹水的良恶性。5.腹膜活检及腹腔镜检查确诊率高,对非肝源性腹水的病因诊断有非常重要的价值。
[Abstract]:Objective to analyze the etiology of non hepatoascites and to explore the diagnostic value of different diagnostic methods for non hepatogenic ascites. Methods 428 patients who were excluded from hepatogeny from October 2006 to October 2016 in general hospital of Ningxia Medical University were collected and admitted to patients with ascites. According to the composition and statistics of general data of patients (age, sex, nationality, clinical symptoms, signs, etc.), laboratory examination (erythrocyte sedimentation, C reactive protein, tumor markers, ascites routine, ascites biochemistry, etc.), imaging examination (ultrasound, CT, MRI, endoscopy, etc.), special examination (peritoneum biopsy, peritoneoscope, etc.), to explore the diagnosis of non hepatic ascites Results 1. causes: the causes of non hepatic ascites were 190 cases of tuberculous ascites (44.4%), 164 cases of malignant ascites (38.3%), 74 cases of ascites (17.3%) the diagnostic value of.2. for non hepatic ascites: 2.1 age, sex, nationality: the average age of malignant ascites was 56.38 + 16.04 years, and the average year of tuberculous ascites was The age of the age was 48.20 + 19.05 years, the average age of ascites was 43.32 + 21.47 years old. The age of malignant ascites was higher than P=0.001 (P0.05) and other causes of ascites (P=0.000, P0.05). The good onset age of malignant ascites was 40-59 years old, tuberculous ascites, and the other etiology of ascites was 20-39 years old. There were no statistical differences (P0.05). But in malignant ascites, women were most common in ovarian and gastric cancer..2.2. laboratory examination was found in men with gastric cancer and unidentified primary peritoneal metastasis: C reactive protein in tuberculous ascites, and ascites adenosine deaminase highest, 38.08 + 29.66 mg/L, 47.94 + 15.11 U/L, and ascites in malignant ascites The acid dehydrogenase was the highest, the mean value was 335.19 + 359.82 U/L, and the serum and ascites CEA, CA199, CA153, and ascites CA125 were significantly higher than the other two groups. The difference was statistically significant (P0.05).2.3. peritoneal biopsy, laparoscopic examination: 54 cases were completed peritoneum biopsy, and 47 cases were diagnosed by histopathology, including 31 tuberculous peritonitis and 16 malignant tumors. The cause still remained. 7 cases were confirmed by 87.0%., 14 cases were diagnosed by laparoscopy, and 12 cases were diagnosed by histopathology, including 7 cases of tuberculous peritonitis, 5 cases of malignant tumor, 2 cases of unknown etiology, and the diagnosis rate was 85.7%. conclusion 1. of the causes of non hepatic ascites were tuberculous ascites, followed by malignant ascites, and the women in malignant ascites were ovarian cancer and malignant ascites. Gastric cancer and metastatic carcinoma of the primary foci are most common in men. The age of.2. malignant ascites is the highest, the age is 40-59 years old. The age of tuberculous ascites, the other etiology of ascites is 20-39 year old.3.C reactive protein, the ascites dehydrogenase, adenosine deaminase has a certain value of.4. ascites in the diagnosis of non hepatic ascites. CA125, serum and ascites CEA, CA199, and CA153 can be used in the diagnosis of non hepatic ascites by.5. peritoneum biopsy and laparoscopy, which is of great value for the diagnosis of non hepatogenic ascites.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R442.5

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