目的 总结对急腹症在病情判断方面的经验。方法 回顾性分析310例急腹症患者的临床资料。结果 即时确诊211例，经短暂观察确诊54例，经手术探查确诊32例，未明确诊断但经保守治疗痊愈好转6例，误诊、漏诊7例，总确诊率为95.8%。结论 急腹症的病情判断和动态观察是明确诊断和及时治疗的前提。只有勤于实践并掌握正确的方法才能提高分析判断能力。
ObjectiveTo explore the diagnostic and therapeutic value of laparoscopy in acute abdomen. MethodsRelated literatures were collected to analyze the advantages, the scope of application, and the effect on the body of laparo-scopy, and to clearly defined the indications of laparoscopy in acute abdomen and related taboos. ResultsMost people could be tolerated for CO2 pneumoperitoneum. Laparoscopic surgery had a certain advantages compared with open surgery in the diagnosis and treatment. It was widely used in the diagnosis and treatment of acute abdomen. ConclusionLaparo-scopic surgery is recommended for acute appendicitis, acute cholecystitis, peptic ulcer perforation, and so on, but it is still controversial in intestinal obstruction, intestinal diverticulum perforation, and the application of abdominal trauma, which need more randomized controlled studies comparing with open operation.
【摘要】目的 探讨腹腔镜技术在急腹症探查术中应用的临床意义。方法 回顾性总结我院行急诊腹腔镜探查及治疗的22例急腹症患者的临床资料。结果 22例经腹腔镜检查全部明确诊断,除1例肠系膜上动脉栓塞的患者中转开腹外，所有手术均在腹腔镜下或辅助下完成，均恢复顺利,无术后并发症及死亡。结论 急诊腹腔镜探查术不仅能对急腹症的病因作出明确诊断,而且可在腹腔镜下完成大部分患者的治疗。
目的 探讨腹腔镜技术在急腹症诊治中的作用。方法 回顾性分析笔者所在医院2008年10月至2011年12月期间收治的128例急腹症患者应用腹腔镜技术进行诊治的临床资料。结果 127例均明确诊断，１例十二指肠迟发性破裂腹腔镜探查漏诊，患者2d后因腹痛剧烈而行剖腹探查术，发现为十二指肠破裂， 确诊率为99.2％。103例（80.5％）于腹腔镜下完成手术，11例（8.6％）中转开腹手术，14例经腹腔镜检查明确诊断后行保守治疗。所有手术患者术后无严重并发症发生，全部患者均痊愈出院。平均手术时间为72min （32 ～166min）；平均出血量为125ml （20～230ml）； 平均住院时间为5d （3～12d）。结论 急腹症应用腹腔镜技术是一种十分安全有效的方法，具有诊断治疗一体化、创伤小、恢复快，住院时间短等优点。
【摘要】 目的 探讨急诊超声在右下腹急腹症诊断中的应用价值。 方法 回顾性分析2008年8月-2009年12月150例右下腹急腹症患者急诊超声检查结果，所有患者均经手术和病理资料或者临床治疗后得到证实，将超声诊断的结果与临床出院诊断进行对比分析。 结果 150例右下腹急腹症患者中，超声正确诊断126例（84%），漏诊18例，误诊6例，其中急性阑尾炎漏诊率最高，漏诊的主要原因为部分患者阑尾解剖位置特殊或者肠道气体干扰。 结论 超声检查能够较准确判断右下腹急腹症的病因。熟悉常见急腹症疾病的临床表现、体征及熟练掌握常见疾病的超声声像图特点，对右下腹急腹症的诊断及鉴别诊断至关重要。【Abstract】 Objective To evaluate acute ultrasonography in diagnosing right hypogastric acute abdomen. Methods The results of acute ultrasonography of 150 patients with right hypogastric acute abdomen were retrospectively analyzed. The disease was confirmed by surgery and pathological examination. The results of ultrasonography and clinical diagnosis were compared. Results Among 150 patients, correct ultrasonography diagnosis was found in 126 (84%), missed diagnosis in 18, and misdiagnosis in six; the highest rate of missed diagnosis occurred in patients with acute appendicitis. Conclusion Acute ultrasonography can feasibly and accurately diagnose right hypogastric acute abdomen. The accuracy depends on the common clinical manifestations and the common diseases ultrasonography characters of right hypogastric acute abdomen.
ObjectiveTo evaluate the value of spiral CT in diagnosing ischemic bowel changes in systemic lupus erythematosus (SLE) patients presenting with acute abdominal pain. MethodsThe clinical data and spiral CT imaging files of 23 SLE patients presenting with acute abdominal pain were retrospectively reviewed. Sixteen had contrastenhanced spiral CT scanning of the abdomen, the rest had plain CT study. Observation emphasis was placed on the changes of bowel wall (wall thickness, enhancement pattern, lumen size) and mesentery (mesenteric edema, engorgement of mesenteric vessels and their abnormal arrangement pattern). Other abnormal findings (e.g. fluid accumulation, changes of abdominal solid organs, lymphadenopathy) were also observed. ResultsNineteen patients had intestinal wall thickening (19/23, 82.6%), with the “target sign” in 12 patients (12/16, 75.0%); Bowel lumen dilatation was present in 16 patients (16/23, 69.6%). Mesenteric swelling with increased density of adipose tissue was noticed in 21 patients (21/23, 91.3%); 18 patients had engorgement of mesenteric vessels (18/23, 78.3%), with comb like arrangement in 4 patients (4/16, 25.0%). Other abnormal findings included ascites, hydrothorax, hydropericardium, hepatosplenomegaly and so on. ConclusionThe most common CT findings in SLE patients presenting with acute abdominal pain are the signs associated with ischemic bowel disease. Contrastenhanced spiral CT is a preferable imaging method for both the diagnosis and differential diagnosis of ischemic bowel disease associated with SLE.