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超声诊断妇科急腹症

【摘要】 目的 总结经腹部B超在妇科急腹症诊断中的应用。方法 回顾分析2007年1月—2009年3月115例妇科急腹症患者的腹部B超检查资料,并将超声结果与最后临床诊断结果进行对比。结果 经腹部超声诊断妇科急腹症的总误诊率7.83%,总符合率为92.17%。结论 腹部超声对妇科急腹症的诊断准确性高,对于超声声像图特征不明显者,应结合患者的病史及实验室检查,可提高诊断准确性。

Condition Judgement and Dynamic Observation of Acute Abdomen

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。

Clinical Features and Formation of Acute Abdomen Caused by Non-Abdomen Diseases

Application of Emergency Laparoscopy in Surgical Acute Abdomen

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。

Laparoscopic Diagnosis and Treatment for the Acute Abdomen and Abdominal Trauma

电视腹腔镜诊断和治疗急腹症及腹外伤50例体会

Advances of laparoscopy in diagnosis and treatment of acute abdomen: understanding from the consensus of European Association for Endoscopic Surgery

Laparoscopy has become a commonly used approach to diagnosis and treatment of acute abdomen, and it has good diagnostic value and therapeutic effect in selective cases. It should be practiced by experienced surgeons in laparoscopic surgery and emergency abdominal surgery. Hemodynamic instability, severe abdominal distension, fecal peritonitis, and tumor perforation are contraindications to laparoscopy. In recent years, more and more acute abdominal diseases can be successfully treated by laparoscopy. Randomized controlled trials have proved the laparoscopic treatment in acute appendicitis, acute cholecystitis, peptic ulcer perforation, acute gynecological diseases was comparable to open surgery, and had advantages of fewer complications and faster postoperative recovery. The utilization of laparoscopy in other diseases such as blunt and penetrating abdominal trauma, small intestinal obstruction, and diverticulitis with perforation remains controversial, and needs more randomized controlled trials to investigate the feasibility of laparoscopic surgery.

Diagnosis and Treatment of Acute Abdominal Pain Caused by Hepatic Hydatid (Reports of 297 Cases)

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.

妇科急诊腹腔镜手术临床分析

【摘要】目的 探讨腹腔镜在妇科急腹症中的临床应用。方法 对2006年8月-2008年12月收治的95例妇科急腹症患者根据不同的病情行腹腔镜手术,观察治疗效果。结果 95例急诊腹腔镜手术全部顺利完成,无一例并发症。结论 应用腹腔镜诊断和治疗妇科急腹症是一种有效、实用、安全的方法。

结肠自发性穿孔的诊断和治疗

【摘要】　目的　总结结肠自发性穿孔的病因、诊断和治疗方法。　方法　回顾性分析2000年－2010年收治的9例因自发性结肠穿孔接受急诊剖腹探查手术患者的临床资料。　结果　平均发病年龄67.6岁（55～84岁），5例有慢性便秘病史；患者均以突发性腹痛起病，2例得到术前确诊。1例行穿孔修补术，6例行穿孔修补或穿孔肠段切除加近端结肠造瘘术，2例行Hartmann手术。治愈出院6例，2例切口感染，1例严重感染。　结论　自发性结肠穿孔好发于老年长期便秘史者，通常预后不良，且术后病死率较高。早期发现和手术治疗、彻底的腹腔内冲洗和严密的术后管理是改善预后的重要因素。