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.
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。
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。
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.
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 approach the clinical values of computer tomography (CT) examination technique and imaging features in abdominal cavity parenchymal organs injury. Methods One hundred and fifty-nine patients with abdominal cavity parenchymal organs injury were examined by CT of plain scan and (or) contrast enhancement, the enhancement included arterial phase, parenchymal phase and the kidney scanning delay phase, the results of CT scanning were compared. Results Ninty-eight cases among 159 patients were diagnosed as the abdominal cavity parenchymal organs injury by the CT, the diagnosis accordance rate was 98.1% (156/159) by operation and follow-up, 22 cases were simple viscus damage or back bone and pelvic fracture, 39 cases were negative, the examination positive rate was 75.5% (120/159). Conclusion The CT can display the parenchymal organ traumatic condition, subcapsule hematoma, retroperitoneal hematoma, seroperitoneum and injured grade. It is the first selective examination to use CT scanning in abdominal cavity parenchymal organ damage, and it has important clinic values to use correct scanning techniques in abdominal injury examination.