目的 探讨经脐自然腔道腹腔内镜手术探查在结核性腹膜炎诊断中的价值.方法 对34例疑诊为结核性腹膜炎的患者采用经脐途径行自然腔道内镜手术探查腹腔,观察腹膜的外观及腹腔内是否存在粘连,并在内镜直视引导下对腹膜病灶行病理活检.结果 34例患者中,经腹膜活检确诊为结核性腹膜炎27例,腺癌3例,腹膜间皮瘤2例,骨外尤文氏肉瘤1例,诊断不明1例.确诊率97.1％.结核性腹膜炎内镜下表现为腹膜上分布大小较均匀,颜色偏白的粟粒状结节,腹膜与脏器间可出现粘连.结论 经脐自然腔道腹腔内镜手术探查是诊断结核性腹膜炎直接而准确的方法.%[Objective] To assess the value of peritoneoscopy via umbilical natural orifice translumenal endo-scopic surgery (U-NOTES) in the diagnosis of tuberculosis peritonitis (TP). [Methods] 34 cases of suspected TP patients received peritoneoscopy via U-NOTES. The appearance of the peritoneum and intraperitoneal adhesions was observed, and peritoneal lesions were biopsied for pathologic demonstration. [Results] Among 34 patients, peritoneal biopsy confirmed 27 cases of TP, 3 cases of adenocarcinoma, 2 cases of peritoneal mesothelioma, 1 case of bone Ewing sarcoma, and in the remaining 1 patient the biopsy was inconclusive. The overall diagnostic rate was 97.1%. Peritoneoscopic appearances of TP were whitish miliary nodules with uniform size over both peritoneal layers, and adhesions between peritoneum and organs. [ Conclusion ] Peritoneoscopy via U-NOTES is a direct and accurate diagnostic method for tuberculosis peritonitis.
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