Ascites Of Unknown Origin In Female Patients: A Retrospective Study Of 132 Cases

Objective:The causes of ascites in female patients are various, and it is often at the advanced stage when ascites occurs in patients with gynecological tumor, and treatment timing will be missed if the right diagnosis hasn't been made in time. The objective of this study was to search for ideal tumor markers and micro-invasive techniques, and discuss the best diagnostic procedure for ascites in order to make a quick and accurate diagnosis.Methods:One hundred and thirty-two female patients with ascites of unknown origin who received treatment at the departments of internal medicine, surgery and gynecology, the First Affiliated Hospital of Medical School, Zhejiang University from December 2005 to March 2010 were adopted for the study. All the patients were distributed into five groups:malignant ascites group (n=53), tuberculous ascites group (n=17), hepatic ascites group (n=22), benign ascites group (n=20) and unexplained ascites group (n=20). The age distribution, causes, clinical manifestations of these patients were analyzed. The characteristics of ascitic fluid based on different causes were compared; the tumor markers in serum and ascitic fluid, and the protein, LDH and ADA levels in ascitic fluid IV were compared between the malignant ascites group and the benign ascites group; the sensitivities were also compared between serum tumor markers and ascitic fluid tumor markers in the malignant ascites group. The sensitivity and specificity of tumor markers in serum and ascitic fluid, the detection rates of ascites with ultrasound scan and CT scan, and the positive rate in cytologic examination of ascitic fluid were calculated respectively. The application of exploratory laparotomy and laparoscopic exploration were also evaluated. Critical Values for laboratory test results were adopted from the reagent datasheets. The software SPSS 16.0 was chosen for statistical analysis, and p<0.05 (two-sided test) represents that there is a statistically significant difference.Results:(1) The average age of these female patients was 56±15 years. The age distribution: hepatic ascites group> malignant ascites group> tuberculous ascites group, and there was significant differences between them. The patients with tuberculous ascites accounted for 21.5% of the patients with the age<55 years. The patients with hepatic ascites accounted for 23.9% of the patients with the age>55 years. The patients with malignant ascites accounted for 30.8% and 49.3% of the patients with the age<55 years and>55 years respectively.(2) The most common causes of ascites for these 132 patients were malignant tumors (40.3%), cirrhosis (16.7%) and tuberculous peritonitis (12.9%). Tumors of the digestive system and the reproductive system accounted for 47.17% of all the malignant tumors.(3) There were significant differences in ascitic LDH, serum and ascitic fluid CA125 levels (p<0.01) and CA199 levels (p<0.05) between the malignant ascites group and the benign ascites group. The ascetic LDH in the malignant ascites group was 3 times the level of the one in the benign ascites group, the serum CA125 in the malignant ascites group was 4 times the level of the one in the benign ascites group and the serum CA199 in the malignant group was 10 times the level of the one in the benign ascites group. The ascitic fluid CA125 in the malignant group was 4 times the level of the one in the benign ascites group and the ascitic fluid CA199 in the malignant group was 100 times the level of the one in the benign ascites group.(4) The sensitivity of serum CA125 was significantly higher than the sensitivity of ascitic fluid CA125 (p<0.05), while the sensitivities of ascitic fluid CA199 and CEA were significantly higher than the sensitivities of serum CA199 and CEA respectively (P<0.05).(5) The detection rates of ultrasound scan and CT scan were 94.4% and 95.6% respectively, but without specificity. The positive rate in cytologic examination of ascitic fluid was 39.6%. And exploratory laparotomy or laparoscopic exploration was always needed for confirmative diagnosis.Conclusions:(1) The feature of ascites of unknown origin in female patients is the complex course of disease, difficult diagnosis, multi-hospital and multidisciplinary stay, big span in age distribution, and primary location of malignant tumors in the list.(2) Three main causes for ascites of unknown origin in female patients which need to be first considered are malignant tumors of the reproductive system, cirrhosis and tuberculous peritonitis. Ovarian cancer is the most common cause for ascites among malignant tumors of the female reproductive system.(3) The levels of LDH in ascitic fluid, CA199 and CA125 in serum and ascitic fluid were of diagnostic value in differentiation between malignant ascites and benign ascites. The detection of ascitic fluid CA199 and CEA was more significant in differential diagnosis than the detection of serum CA199 and CEA for malignant ascities patients.(4) Diagnostic laparoscopy should be performed as soon as possible when malignant ovarian tumor is suspected in order to make confirmative diagnosis as early as possible.