淋病性腹膜炎临床诊断回顾(附30例报告)

作者对30例淋病性腹膜炎临床诊断进行回顾分析。13例因误诊而行探腹术，其中11例误诊为急性阑尾炎、阑尾穿孔（84．6％），1例误为胆囊炎、胆石症（7．7％），1例误为卵巢黄体破裂（7．7％）。大多数病例有不洁性生活史。通常有以下特点：（1）就诊较晚；（2）无典型脐周转移右下腹疼痛史；（3）强直体位不明显；（4）腹部肌卫较轻，（5）右下腹压痛点固定不明显。本组30例从腹腔渗液或从阴道粘液均查见淋病双球菌（PCR技术）。结论是：从本组诊断经过中认为淋病性腹膜炎最易误诊为急性阑尾炎、阑尾穿孔。应根据病史，症状和实验室检查加以鉴别以避免不必要的剖腹探查术。

CLINICAL DIAGNOSTIC RETROSPECTION OF GONOCOCCAL PERITONITIS WITH REPORT OF 30 CASES

30 cases with gonococcal peritonitis were reviewed. 13 patients were performed on laparotomy becauseof misdiagnoss, of whom 11 were misdiagnosed as acute appendicitis and appendical perforation, 1 as cholecystitis.and choledolithiasis (7. 7%), 1 as ovary luteal rupture (7. 7%). Most of the patients had a history of a disturbedsexual intercourse and were generally characterized by the following manifestations: 1) delayed diagnosis and treat-ment;2) no typical metastasized pain from the periumbilicus to the right hypogastric region;3) no apparent stiffattitude; 4) only showing slight guarding; 5) no determinate fastening point with tenderness at the right hypogas-tric region. Gonococci were identified in all patients (by PCR method), either from the peritoneal cavity effusionor from the vaginal mucus. Conclusion: It is concluded that gonococcal peritonitis is most likely to be misdiagnosedas acute appendicitis and appendiceal perforation. Clinical history, symptoms and laboratory examination resultsare essential in order to evade unnecessary laparotomy.