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1.
闭孔疝的CT诊断1例   总被引:1,自引:0,他引:1  
病例女,82岁,腹痛,腹部胀气,停止排便、排气1天,伴呕吐。体检:全腹压痛,反跳痛,偶闻气过水音,实验室检查,白细胞13.2×109蛐L,中性0.92,B超:肠袢扩张,积气,积液,CT平扫:空回肠大量积液,可见液气平面,右侧闭孔内可见肠气(图1),右耻骨肌和闭孔外肌之间可见软组织阴影(图2),软组织阴影内可见积气(图3),CT诊断:右侧闭孔疝,小肠梗阻。手术所见:空肠大量积液,空肠下段嵌入右侧闭孔内5cm。形成完全梗阻,嵌顿小肠壁明显水肿,不能回纳复位,术后诊断,右侧闭孔疝。图1空回肠大量积液,可见液气平面,右侧闭孔内可见肠气。图2右耻骨肌和闭孔外肌间可见…  相似文献   

2.
患者女,49岁,因反复腹痛、腹胀3个月,加重并肛门停止排便排气2天入院。1年前曾行阑尾切除术。查体:生命体征正常。腹部膨隆,脐周压痛,全腹鼓音,移动性浊音阳性,肠鸣音弱。血常规检查:WBC9.5×109/L,N75%。立位X线检查示腹部多个液气平面呈阶梯状。诊断为粘连性肠梗阻。观察约12小时患者自觉腹痛加重,急诊行剖腹探查术,术中见腹腔内有淡红色腹水约2000ml,小肠中度胀气,未见粘连带,脐下偏右有一约15cm×10cm×8cm肿块,表面充血水肿和少量散在坏死灶,为回肠套入回肠所致。将套入的回肠复位后见距回盲部20cm至150cm回肠坏死,恶臭。坏死肠段肠…  相似文献   

3.
1 病例摘要 患者女,61岁,因"突发右下腹、右髋部疼痛6 h"入院.查体:腹软,无肌卫,右下腹明显压痛,反跳痛(+),肠鸣音增强.腹股沟未及包块.腹部立卧位片示:小肠积气.少许液平.骨盆CT示:右侧耻骨肌和闭孔外肌间可见大小约2.5 cm软组织影,内呈低密度,近端肠管明显扩张,伴有液平.诊断为:闭孔疝,小肠肠梗阻.转入外科急诊手术探查,发现嵌顿小肠不易拉出,有3 cm长的小肠肠管缺血坏死,将坏死肠管切除,行断端吻合,手术顺利.  相似文献   

4.
闭合性肠及肠系膜损伤的CT影像特点   总被引:2,自引:0,他引:2  
目的:探讨闭合性肠及肠系膜损伤的CT影像特点,提出防范误诊的措施.方法:回顾性分析1例车祸伤后闭合性肠及肠系膜损伤的临床资料,重点讨论影像误诊原因.结果:本例临床表现为腹部间歇性隐痛,疼痛定位不明确.B超检查示腹腔微量积液、胆囊多发结石;伤后1小时CT扫描示肝下极周缘有极少量积液.伤后48小时腹痛加重,感恶心,无呕吐,中下腹偏右侧压痛明显,查体腹部略膨隆,全腹压痛、反跳痛,右侧腹部明显,腹肌稍紧张.再次腹部B超检查提示腹腔积液,肠梗阻?腹部立位X线平片示肠管积气、轻度扩张,双膈下未见明确游离气体影;全腹CT扫描示腹部肠管积气、积液、扩张,回盲部肠管聚拢、肠间隙模糊伴腹腔、盆腔少量积液,术后明确诊断为肠及肠系膜损伤.结论:腹部闭合性损伤早期行CT检查能显示肠及肠系膜损伤的直接征象及多种间接征象,具有高度的敏感性和特异性,且能了解病变的部位、范围及周围情况,为临床确定治疗方案提供客观依据.  相似文献   

5.
1 病例资料
  男,69岁。因阵发性上腹痛8 d,加重1 d 入院。患者8 d 前饱餐后劳动中出现上腹部疼痛,阵发性发作,伴腹胀、恶心、呕吐,呕吐物为胃内容物。经当地医院治疗无好转。1 d 前腹痛、腹胀加重,呈持续性绞痛阵发性加剧,伴频繁恶心、呕吐,肛门停止排气排便,遂来我院就诊。无腹部手术史。查体:体温37.5℃,脉搏90/ min,呼吸21/ min,血压160/100 mmHg。心肺听诊未见异常;腹膨隆,未见胃肠型及蠕动波,无腹壁静脉曲张,全腹压痛、肌紧张,以上腹部为著,无反跳痛,肝脾肋下未触及,全腹叩诊呈鼓音,移动性浊音阳性,肠鸣音亢进,闻及高调肠鸣音及气过水声。查血白细胞18×109/ L,中性粒细胞0.90。腹部 X 线平片示:左上及中腹部肠积气,肠管扩张,中腹部见两个长气液平面。腹部彩色多普勒超声示:腹腔积液,最深处约5.2 cm。入院诊断:腹痛原因待查(急性肠梗阻?肠扭转?肠道肿瘤?)。给予胃肠减压、抗感染、补液等治疗,但腹痛加重,测心率140/ min,血压80/50 mmHg。再次查体示:腹部膨隆加重,未见胃肠型及蠕动波,全腹压痛、肌紧张、反跳痛,全腹叩诊呈鼓音,移动性浊音阳性,肠鸣音消失。考虑急性绞窄性肠梗阻。入院后8 h 在抗休克同时行剖腹探查,术中见腹腔内约800 ml 血性腹腔积液,小肠扭转并呈黑色,横结肠系膜见一裂孔,肠管由此疝入并扭转。于横结肠系膜无血管区切开疝环,松解后将肠管复位,见裂孔位于横结肠中动脉右侧,自Treitz 韧带1.5 m 以下至距回盲部20 cm 以上的小肠及肠系膜坏死,切除坏死肠管及系膜,行空肠、回肠断端吻合术,修补横结肠系膜裂孔。术后诊断:先天性横结肠系膜裂孔疝,急性绞窄性肠梗阻并肠坏死;感染性休克;弥漫性腹膜炎。术后予胃肠减压、抗感染及对症支持治疗,痊愈出院。  相似文献   

6.
本案介绍的这例年轻的肠扭转梗阻患者利用肠镜支架植入术,避免了开腹手术,为治疗赢得时间,现报道如下. 病例介绍 患者,男,18岁,2012年9月14日2:03入院,腹胀腹痛伴肛门停止排气、排便3d.1:40腹部CT提示腹部肠腔内明显积气扩张,部分小肠积液.血常规:白细胞12.8 × 109/L,N84.4%,经胃肠减压,抗感染、营养支持治疗,甘油灌肠剂灌肠后症状未见改善,9:21腹部立卧位片提示结肠不完全肠梗阻.9:50下腹部CT平扫提示下腹部及盆腔内广泛积气积液伴液平.16:30急诊肠镜检查距肛门40 cm处局部肠腔闭合,黏膜充血水肿,吸引后未见气泡及粪水溢出,考虑为肠扭转梗阻,立即行肠镜下金属支架植入术.  相似文献   

7.
例1,男,生后3天,呕吐,腹胀,肛门无排便。查体:腹部膨隆,叩鼓,腹壁静脉显露,隐约可见肠型,肠鸣音弱,未扪及包块。X线平片:小肠明显充气扩张,腹中部可见“咖啡豆”样充气扩张之肠拌,揭示肠梗阻。钡灌肠:全结肠细小,呈蚯蚓状,结肠内径约0.5cm。内有散在的颗粒状胎类,回肠远段未见钡充盈(图1)。  相似文献   

8.
1病例资料男,1·5岁。患儿于3天前无明显原因哭闹不安,呕吐频繁,呕吐奶汁样物,排黑色糊状大便1次,入我院。查体:体温37℃,呼吸24/m in,脉搏116/m in。心肺未见异常。腹部膨隆,无明显胃肠蠕动波,全腹压痛、反跳痛,尤以左中上腹明显,伴肌紧张,肠鸣音亢进。医技检查:血红蛋白75 g/L,白细胞20·3×109/L,中性粒细胞0·60,淋巴细胞0·33。粪隐血试验(2 )。X线腹透示:肠管大量积气。B超示:左中上腹见4·7 cm×6·5 cm无回声暗区,内见强回声带漂浮。行剖腹探查术,术中见囊性肿物位于距屈氏韧带50 cm的空肠,约5 cm×5 cm×4 cm大小,囊肿位于肠系膜…  相似文献   

9.
肠系膜血管栓塞致肠缺血的CT诊断   总被引:1,自引:0,他引:1  
目的:分析肠系膜血管栓塞致肠缺血的CT表现,提高对本病的CT诊断水平。材料与方法:回顾性分析经临床及病理证实的13例肠系膜血管栓塞的CT平扫及增强表现。结果:10例患者表现出肠系膜血管栓塞直接征象:受累血管内见栓子,其中7例患者CT平扫即表现为系膜血管增粗,管腔密度增高或减低,1例患者因就诊较晚直接表现为系膜血管及门静脉内积气;2例患者CT平扫未见明显系膜血管病变,增强扫描表现为管腔充盈缺损;另3例患CT平扫系膜血管未见异常改变,剖腹探查术后病理证实为系膜血管栓塞。13例患者均表现出肠系膜血栓的间接征象肠缺血:其中11例表现为肠腔扩张积气积液;8例肠壁增厚;5例肠壁变薄;4例肠壁密度增高;2例肠壁积气;4例出现肠系膜水肿;1例系膜内积气;4例肠缺血并发腹膜炎出现腹水。结论:腹部CT检查尤其是增强扫描可直接显示肠系膜血管及其主要分支的管腔情况,对肠系膜血管栓塞致肠缺血具有很高的诊断价值,对不明原因的急性腹痛患者应作为首选检查方法。  相似文献   

10.
1 病历摘要 男,78岁.因上腹持续剧痛20 h,在当地医院就诊无效来我院门诊就医,以消化道溃疡穿孔收入院.查体:T 37.2 ℃,P 80次/min,R 20次/min,BP 140/80 mm Hg.瘦体型,急性痛苦病容,呻吟,皮肤黏膜无黄染,心肺听诊无异常,板状腹,全腹散在压痛,以上腹为甚.肝浊音区存在,肝脾肋下,未扪及,莫菲氏征(-).血WBC 9.8×109/L,N 0.84.腹部透视见膈下可疑游离气体,未见肠腔内积气及液平,腰大肌及腹脂线欠清楚,放射学诊断:消化道溃疡穿孔、腹膜炎.急诊术前准备后即在持续硬膜外麻醉下行剖腹探查术.术中见胃十二指肠无溃疡瘢痕.小肠、结肠空虚,胆囊约8 cm×6 cm大小,顺时针扭转720°,发黑、坏死、张力高,穿刺抽出暗红色血性液体,胆总管不增粗.手术常规切除胆囊.术后诊断:急性胆囊扭转坏死出血,术后经抗炎综合治疗1周痊愈出院.  相似文献   

11.
Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm?1 MHz?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.  相似文献   

12.
SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.  相似文献   

13.
Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.  相似文献   

14.
张怡然 《临床荟萃》2020,35(9):783-787
目的 甲状旁腺功能减退(甲旁减)性心肌病是一种罕见的心脏疾病,为扩张型心肌病中少数可逆转的一种,常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例,采用统计分组法对纳入研究的文献进行分析,依据系统综述和meta分析优先报告条目(PRISMA声明)进行报告。结果 在我们筛查出的41例患者中,女性居多(68.29%),平均年龄为45.5岁,各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减(78.05%),颈部手术导致的甲旁减性心肌病次之(17.07%)。患者均以心力衰竭就诊,伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史,90%的患者左心室射血分数降低。该病误诊漏诊率较高,仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键,90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。  相似文献   

15.
目的 探讨术前单核细胞与高密度脂蛋白比值(monocyte to high density lipoprotein cholesterol ratio, MHR)与经皮冠状动脉介入(percutaneous coronary intervention , PCI)治疗后发生造影剂肾病(contrast induced nephropathy, CIN)的相关性,为CIN的发生寻找其他可能的危险因素,为及早筛选CIN高危人群提供新的方向。方法 回顾性分析5P试验入选的我院心内一科行经皮冠状动脉介入治疗术的冠心病患者1 087例,根据在PCI术后是否发生造影剂肾病分为CIN组和非CIN组,研究CIN的相关危险因素,分析MHR与造影剂肾病的相关性,应用Logistic回归分析查看MHR是否为CIN发病的高危因素。结果 CIN组共57例,非CIN组1 030例。两组在高脂血症、BMI、左心室射血分数(LVEF)、术前尿酸及术前C 反应蛋白水平等方面比较差异有统计学意义(P<0.05)。 Logistic回归分析显示LVEF及糖尿病与造影剂肾病的发生相关。结论 同以往研究结果不同,MHR并不能作为CIN的危险因素,但LVEF对于CIN可能具有更高的预测价值。  相似文献   

16.
Objective. Our objective was to quantify the effects of intravenous anesthetics on values measured by or derived from transcranial Doppler sonography (TCD) during induction of general anesthesia.Methods. We recorded blood flow velocity in the middle cerebral artery (V-MCA) before, during, and after induction of general anesthesia in six groups of young patients without intracranial pathology (n=10 each) using TCD. Patients were randomized to receive either 2 mg/kg propofol, 1.5 mg/kg methohexital, 5 mg/kg thiopental, 0.3 mg/kg etomidate, 2 µg/kg fentanyl and 0.15 mg/kg midazolam, or 1.5 mg/kg ketamine and 0.15 mg/kg midazolam intravenously. At 2 min after injection, each patient was intubated and given isoflurane 0.8% and nitrous oxide 66% in oxygen. Ventilation was set to achieve an end-tidalPco 2 of 40 mm Hg. V-MCA, arterial blood pressure, heart rate, hematocrit, andPco 2 (venous samples) were measured before and 1, 3, 5, 10, and 30 min after induction of anesthesia.Results. The preinduction data were not different between groups. At 1 min after injection, propofol, thiopental, methohexital, and etomidate significantly decreased V-MCA. TCD values were only slightly affected following fentanyl/midazolam. Ketamine/midazolam induced a modest rise in V-MCA. After endotracheal intubation, V-MCA increased in all groups, and slowly declined thereafter.Conclusions. Under the circumstances of our study, values derived from TCD measurements responded differently to the agents used to induce general anesthesia in nonneurosurgical patients.  相似文献   

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18.
目的 探讨百色地区壮族人群受试者β2 肾上腺素能受体(β2 AR)基因多态性与高血压的关系和原发性高血压的遗传学特征。方法 98例高血压病例患者,患病史至少两年。同时还有109例健康的对照受试者。对所有受试者进行基本的体格检查及空腹血浆生化指标的测定,然后再使用多聚酶链反应技术(polymerase chain reaction,PCR)对DNA进行分析,以鉴定β2 AR基因rs6879202与rs2053044的位点的基因型和等位基因频率。并采用SPSS 19.0 软件中回归模块中的Logistic对有显著性统计学差异的位点的基因频率诱发高血压的危险性进行了一定的探讨。结果 病例组与对照组在性别比、肌酐、吸烟率、甘油三酯、尿酸等之间有统计学差异。病例组和对照组β2 AR基因rs6879202位点CC、CG、GG基因频率分别为3.10%,72.40%,24.50%;13.80%,57.80%,28.40%;两组的基因型频率分布之间有统计学意义(χ2=8.809,P=0.012)。Logistic分析结果表明对rs6879202位点而言CG较其他两个基因频率诱发高血压的风险更大。结论 百色地区壮族患者β2 AR基因rs6879202位点多态性与原发性高血压有相关性,而β2 AR基因rs2053044位点多态性与该地区该民族的原发性高血压没有相关性。  相似文献   

19.
目的分析总结小肠克罗恩病肠道及肠周病变的超声图像特征。 方法回顾性选取2009年6月至2019年6月南京医科大学附属苏州医院收治的临床已确诊小肠克罗恩病的患者25例,共计进行42人次经腹肠道超声检查。对其病变肠壁、肠壁外腹部并发症的超声图像及小肠克罗恩病的活动度评估结果进行分析总结。 结果病变肠壁表现:主要表现为肠壁增厚(41/42),多为全周性及全层性增厚,最厚段36人次位于下腹部,其中以右下腹最多(30/36,83.3%);活动期及严重者肠壁层次消失(16/42),僵硬,蠕动消失;26人次病变肠壁发现深达肠壁各层的溃疡。并发症表现:15人次出现狭窄,图像特征为肠壁增厚、肠腔变窄及近端肠管扩张;8人次出现瘘,图像特征为肠壁与其他器官之间的条状或分支状低回声带,含有或不含有气体强回声;爬行脂肪征30人次,图像特征为高回声脂肪团块包绕肠壁;肠系膜淋巴结炎20人次,其中18人次病灶长径<20 mm,为多发;腹腔积液16人次;腹部包块9人次,其中脓肿5人次,图像特征为炎性肿块内或肠系膜区局限性液区,透声差,无血流信号;穿孔1人次,超声图像表现为肠壁增厚,连续性中断,局部肠壁外见低回声区,腹腔内见游离液区,液区透声差;炎性息肉8人次,单发或多发,超声图像特征为凸入肠腔内的低回声或等回声凸起;憩室形成3人次,图像表现为局部肠壁变薄膨出,多位于系膜缘。活动期(超声评估)狭窄、爬行脂肪征、肠系膜淋巴结炎、腹腔积液等的发生率均明显高于缓解期(超声评估),差异均有统计学意义(P=0.002、0.000、0.024、0.025);活动期(超声评估)肠壁和爬行脂肪的最大厚度平均值明显大于缓解期(超声评估),差异均有统计学意义(P均=0.000)。超声与Harvey-Bradshaw指数对小肠克罗恩病活动性评估的一致性较好(Kappa=0.897,P<0.05)。 结论经腹肠道超声能够清晰显示小肠克罗恩病的肠道病变及肠外并发症的改变,可以较准确地评估病变的活动度,且操作灵活,患者依从性好,可以作为小肠克罗恩病的常规影像学评估工具。  相似文献   

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The dominant pattern and location of calcifications occurring within 23 primary gastrointestinal tumors have been analysed and correlated with the data from the literature. The provided guidelines for radiologic diagnosis of such calcified tumors include: (1) a retrocardiac mass containing amorphous calcifications is typical of leiomyoma of the esophagus; (2) calcific deposits similar to that in uterine fibroids may be the feature of gastric leiomyoma or intestinal leiomyosarcoma; (3) sand-like deposits within the wall of the stomach or colon are characteristic of a mucinous adenocarcinoma; (4) clusters of phleboliths in the gastrointestinal wall suggest a hemangioma particularly if recurrent intestinal bleeding and cutaneous hemangiomas are associated; (5) sunburst type of calcification in the pancreas indicates a cystadenoma or cystadenocarcinoma of that organ; and (6) aggregates of granular calcifications in the liver are diagnostic for metastatic adenocarcinoma of the colon but may rarely be seen in a primary malignancy of the liver.  相似文献   

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