最近稀な結核性腹膜炎の2例―腹腔鏡は診断，治療効果判定に有効である―

Two cases of tuberculous peritonitis : laparoscopic examination was effective for diagnosis and therapeutic evaluation

◆要旨：結核性腹膜炎は比較的稀な病態だが，不明熱，慢性的な腹部症状の原因として重要である．ツベルクリン反応，腹水塗抹，PCR法など一般的な結核に対する検査法では診断が困難であり腹腔鏡による診断が有効である．当院では過去十年間に2例の結核性腹膜炎を経験したが，いずれもツベルクリン反応，腹水塗抹検査，PCR法では確診に至らず腹腔鏡下生検により診断が確定できた．そのうち1例は6か月の抗結核療法後も炎症所見が遷延したために再度腹腔鏡検査を行い著明な改善を確認した．結核性腹膜炎の診断，治療効果判定に対する腹腔鏡検査の有効性につき若干の文献的考察を加えて報告する．

　Tuberculous peritonitis is a relatively rare disease, but recently has been increasing. Tuberculous peritonitis is difficult to diagnose with ascites culture, PCR analysis, and other biochemical analysis. In our case, tubercle biopsy with laparoscope was effective for diagnosis, and for therapeutic evaluation.

　We present two cases of tuberculous peritonitis which were difficult to diagnose, and biopsy with laparoscope was effective. In one case, after 6 months of chemotherapy, laparoscopic examination for therapeutic evaluation was performed. There were no tubercule nor adhesion. Laparoscopic examination for diagnosis & evaluation was safe and effective.