本文選題：腹水 + 病因?qū)W　； 參考：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的分析非肝源性腹水的病因構(gòu)成,探討不同診斷方法對非肝源性腹水的診斷價值。方法收集2006年10月至2016年10月寧夏醫(yī)科大學(xué)總醫(yī)院排除肝源性因素的428例“以腹水原因待查”收住入院患者。根據(jù)患者資料分析非肝源性腹水的病因構(gòu)成。整理并統(tǒng)計患者一般資料(年齡、性別、民族、臨床癥狀、體征等),實驗室檢查(血沉、C反應(yīng)蛋白、腫瘤標(biāo)志物、腹水常規(guī)、腹水生化等)、影像學(xué)檢查(超聲、CT、MRI、內(nèi)鏡等)、特殊檢查(腹膜活檢、腹腔鏡等)結(jié)果,探討其對非肝源性腹水的診斷價值。結(jié)果1.病因構(gòu)成:非肝源性腹水病因按比例依次為結(jié)核性腹水190例(44.4%)、惡性腹水164例(38.3%)、其他病因腹水74例(17.3%)。2.診斷方法對非肝源性腹水的診斷價值:2.1年齡、性別、民族:惡性腹水平均年齡為56.38±16.04歲、結(jié)核性腹水平均年齡為48.20±19.05歲、其他病因腹水平均年齡為43.32±21.47歲,惡性腹水年齡高于結(jié)核性腹水(P=0.001,P0.05)及其他病因腹水(P=0.000,P0.05)。惡性腹水好發(fā)年齡為40-59歲,結(jié)核性腹水、其他病因腹水好發(fā)年齡為20-39歲。不同性別、民族非肝源性腹水病因構(gòu)成無統(tǒng)計學(xué)差異(P0.05)。但惡性腹水中,女性以卵巢癌及胃癌多見,男性以胃癌及原發(fā)灶不明的腹膜轉(zhuǎn)移癌多見。2.2.實驗室檢查:結(jié)核性腹水中C反應(yīng)蛋白、腹水腺苷脫氨酶最高,均值分別為38.08±29.66 mg/L、47.94±15.11 U/L;惡性腹水中腹水乳酸脫氫酶最高,均值為335.19±359.82 U/L,且血清及腹水CEA、CA199、CA153、腹水CA125較其他兩組明顯升高,差異有統(tǒng)計學(xué)意義(P0.05)。2.3.腹膜活檢、腹腔鏡檢查:完成腹膜活檢54例,最終經(jīng)組織病理確診47例,其中結(jié)核性腹膜炎31例,惡性腫瘤16例,病因仍不明7例,確診率87.0%。完成腹腔鏡檢查14例,最終經(jīng)組織病理確診12例,其中結(jié)核性腹膜炎7例,惡性腫瘤5例,病因仍不明2例,確診率85.7%。結(jié)論1.本研究中非肝源腹水病因中以結(jié)核性腹水最多見,其次為惡性腹水。惡性腹水中女性以卵巢癌及胃癌多見,男性以胃癌及原發(fā)灶不明的腹膜轉(zhuǎn)移癌多見。2.惡性腹水發(fā)病年齡最高,好發(fā)年齡為40-59歲。結(jié)核性腹水、其他病因腹水好發(fā)年齡為20-39歲。3.C反應(yīng)蛋白、腹水乳酸脫氫酶、腺苷脫氨酶對非肝源性腹水的病因診斷有一定價值。4.腹水CA125、血清及腹水CEA、CA199、CA153可用于鑒別非肝源性腹水的良惡性。5.腹膜活檢及腹腔鏡檢查確診率高,對非肝源性腹水的病因診斷有非常重要的價值。
[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.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R442.5

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