目的:探讨经胃入路的经自然腔道内镜手术( natural orifice transluminal endoscopic surgery,NOTES)在诊断不明原因腹水中的临床价值.方法:回顾性分析自2016年4月至2019年3月在我院住院的行经胃NOTES术(32例)及腹腔镜术(32例)以诊断不明原因腹水患者的病历资料,对比分析患者确诊率、术后疼痛程度、术后并发症、住院时间、手术时间、住院费用等数据.结果:两组确诊率分别为NOTES术84. 4% ,腹腔镜术93. 8% ,两组确诊率之间差异无统计学意义(P=1. 44).术后均无腹腔感染、胃壁/腹壁切口出血、穿孔、穿刺口/切口瘘等并发症发生. NOTES 组手术时间短于腹腔镜组,两组比较差异有统计学意义(P<0. 001). NOTES组术后腹痛评分低于腹腔镜组,两组比较差异有统计学意义(P=0. 003).两组平均住院时间及住院费用无统计学差异.结论:经胃NOTES术对不明原因腹水的诊断具有诊断率高、创伤小、并发症少等优势,是一种安全、有效、经济的诊断不明原因腹水诊断的手术方法.“,”Objective: To assess clinical value of transgastric natural orifice transluminal endoscopic surgery (NOTES) in diagnoses of patients with ascites of unknown origin. Methods: We retrospectively analyzed the clinical data of patients who underwent NOTES (32 cases) and laparoscopic surgery (32 cases) and were diagnosed as ascites of unknown origin in our institute from April 2016 to March 2019. Patients’ diagnosed rate, postoperative pain, postoperative complications, hospital stay, operation time and hospitalization costs were statistically analyzed. Results: Diagnosed rate in the NOTES group was 84. 4% while that in the laparoscopic group was 93. 8% , and there was no statistically significant difference between two groups (P=1. 44). Abdominal infection, bleeding from incision of stomach wall or abdominal wall, perforation, puncture fistula, incision fistula or other complications after surgery were not observed in both groups. The surgical time was shorter in the NOTES group than that in the laparoscopic group (P<0. 001). The visual analogue scale of postoperative pain was lower in the NOTES group than that in the laparoscopic surgery group (P=0. 003). There were no statistically signif- icant differences in hospital stay and hospitalization costs between two groups. Conclusion: Transgastric NOTES is a safe, valid and economical method in diagnoses of patients with ascites of unknown origin, with high diagnosis rate, minimal inva-sion and few complications.