目的:探讨B超检查对急腹症的临床应用价值。方法:回顾性分析326例急腹症的超声表现并与手术后、病理诊断以及随访结果进行对照。结果:326例急腹症中以急性胆囊炎、输尿管结石、急性阑尾炎以及妇科急症常见,共289例,占88％,其他急腹症37例,占12％。经手术和病理证实217例,109例临床随访证实。超声符台率89.9％。结论:B超检查对急腹症的早期诊断以及鉴别诊断具有重要临床意义,是急腹症首选的诊断方法。
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.
自1985年第一例腹腔镜胆囊切除术成功，腹腔镜逐渐成为治疗结石性胆囊疾病的金标准。近10年来其应用范围迅速扩展，并被广大普外科医生接受和认可，开创了医学领域高速发展的历史新纪元。急腹症是指能够引起急腹痛的腹腔内急性病变，要求外科医生做出快速、准确判断，而不允许花费更多的时间做全面的辅助检查。要想做出快速诊断又不耽误病情，近年来微创外科同行认识到腹腔镜兼有诊断和治疗的特点，在外科急腹症中发挥了重要的作用，现分述之。
ObjectiveTo investigate the feasibility of laparoscopy in the diagnosis and treatment of acute abdomen. MethodsThe clinical data of 81 patients with acute abdomen treated in our hospital from January 2012 to December 2013 were retrospectively analyzed. ResultsOf the 81 patients with acute abdomen, there were 38 cases of acute appendicitis, 15 cases of gastric perforation, 10 cases of duodenal ulcer perforation, 10 cases of acute cholecystitis, 1 case of mesenteric artery embolism, 2 cases of internal hernias, 2 cases of ileocecal tumor, 2 cases of sigmoid colon rupture, 1 case of intestinal adhesion. The 81 cases were treated by laparoscopy, including 79 cases (97.5%) were clearly diagnosed; 73 cases were succeeded by laparoscopy, and 8 cases converted to laparotomy. The operation time were 35-191 minutes, with an average of 76 minutes; the intraoperative blood loss were 20-130 mL, with an average of 43 mL; the postoperative hospital stay were 3-13 days, with an average of 5.6 days. Seventy-six patients received followed-up for 2-24 months, and the median time were 14 months, no special complications occurred during follow-up period, but 1 case of ileocecal tumor suffered from lung metastases in 12 months after operation. ConclusionsLaparoscopy can be used in the preferred way of diagnosis and treatment of acute abdomen.
Objective To summarize the experience of diagnosis and treatment of acute abdominal pain caused by hepatic hydatid. Methods The preoperative diagnosis, the surgical methods and the curative effect after operation of 297 patients with acute abdominal pain caused by hepatic hydatid who were treated in our hospital from 1960 to 2004 were analyzed. Results The healing rate was 95.96% (285/297 cases), and the death rate was 4.04% (12 /297 cases). Six out of 12 cases of death were caused by diffusive biliary peritonitis and allergic shock attributable to the rapture of hydatid into abdominal cavity. Two patients died of malnutrition caused by the spreading of Echinococcus and the correspondingly repeated operations. Another 4 patients with giant hydatid containing 7 000-12 000 ml fluid, died of hepatic insufficiency caused by the postoperative infection in the cyst. Conclusion The acute abdominal pain caused by hepatic hydatid should be treated mainly through emergency operation and the necessary antianaphylaxis, anti-infection and antishock therapies should also be used at the same time.