盲肠浆膜下阑尾9例分析

我院 1990～ 2 0 0 0年行阑尾切除 5 5 6例 ,其中盲肠浆膜下阑尾 9例 ,占 1.6 % ,现报告如下。1　临床资料1.1　一般资料　本组男 4例 ,女 5例 ,年龄 13～ 5 2岁。发病距就诊时间 2～ 15 d。均具有较典型转移性右下腹痛和右下腹马氏点固定压痛表现 ,1例右下腹扪及包块。术前诊断明确 ,手术治疗及时。1.2　手术情况　 1刀口选择 :5例临床表现典型者取右下腹麦氏切口。3例虽症状典型而腹膜炎较重 ,腹壁厚者取右下腹半月线切口。 1例右下腹包块者取右下腹探查切口。 2手术所见 :进腹后见有束状大网膜与盲肠有程度不同的粘连 ,盲肠位置正常 ,均…     

浆膜下阑尾切除术226例分析

我们采用阑尾浆膜下切除的方法治疗不同类型的阑尾炎2 2 6例 ,收到良好效果。现总结报告如下。1　临床资料1 .1　一般资料　本组男 1 79例 ,女 47例 ;年龄最小 1 2岁 ,最大79岁。其中急性单纯性阑尾炎 53例 ,慢性阑尾炎 72例 ,阑尾周围粘连 31例 ,盲肠或回肠后位阑尾 6 4例 ,高     

罕见变异性阑尾误诊为典型阑尾炎1例分析

对罕见变异性阑尾误诊为典型阑尾炎1例分析如下. 1 病历摘要 女,48岁.主因转移性右下腹疼痛1 d入院.1 d前无明显诱因出现上腹疼痛,数小时后转移至右下腹,腹痛呈持续性,阵发性加剧,伴发热,无恶心、呕吐.既往有右侧卵巢切除史20 a,胃病史2 a.入院查体: T 39.0 ℃,P 96次/min,R 19次/min,BP 120/80 mm Hg.     

B超误诊浆膜下子宫肌瘤1例

患者,女性,38岁。主因下腹坠痛伴尿频半年,发现左附件区肿物3天就诊。以盆腔肿物(左卵巢囊肿)收入院。患者月经正常,腹部平坦,无压痛、反跳痛,肠鸣音正常。妇科指诊:宫体大小正常,于子宫左侧可触及一囊实性肿物,可移动。B超提示:子宫     

阑尾粘液囊肿误诊为阑尾炎

1 病例资料男,46岁。因反复右下腹痛1年入院。查体:体温36.5℃,血压112/90mmHg,全身浅表淋巴结无肿大,心肺检查无异常。肝脾未触及,麦氏点明显压痛,无肌紧张及反跳痛,未扪及包块,肠鸣音4/min,无移动性浊音,结肠充气试验（-）,腰大肌试验（±）。血常规:白     

浆膜下阑尾切除术201例分析

目的：介绍阑尾炎浆膜下切除的手术经验。方法：201例阑尾炎患者采用浆膜下阑尾切除术。结果：全组均顺利切除。未出现腹腔内出血、肠瘘及腹膜炎等并发症。结论：与传统方法相比较,采用浆膜下切除的方法,减少了术后并发症的发生,使于术局部更符合生理解剖,有利于患者的术后恢复。     

腹腔镜下阑尾切除术与传统阑尾切除术的临床对比研究

目的:分析对比腹腔镜下阑尾切除术与传统阑尾切除术治疗阑尾炎临床效果。方法:选取2015年3月~2016年8月我院阑尾炎患者75例,根据手术方式分组,观察组38例行腹腔镜下阑尾切除术,对照组37例行传统开腹式阑尾切除术。对比两组手术情况,统计并发症发生率。结果:观察组肛门排气时间、下床时间均短于对照组,术中失血量、止痛药使用比例均少于对照组,差异有统计学意义(P0.05),两组手术时间比较,差异无统计学意义(P0.05);观察组并发症发生率7.89%(3/38)低于对照组29.73%(11/37),差异有统计学意义(P0.05)。结论:相较于传统阑尾切除术,腹腔镜阑尾切除术具有创伤小、并发症发生率低、术后恢复快等优势。     

阑尾腺癌四例误诊

【病例】男3例,女1例;年龄46~72岁,平均58·5岁。以转移性右下腹痛为首发表现3例;下腹部隐痛3个月,加重2天1例。右下腹麦氏点压痛及反跳痛3例,腰大肌试验阳性2例。4例查血白细胞为(10·2~13·5)×109/L。均诊断为急性阑尾炎,行手术治疗。术中见3例阑尾长分别为8 cm、6 cm、4·5 cm,远端膨大、粘连并有脓性渗出;另1例阑尾远端有坏疽穿孔,腹腔有脓性液体。术后病理诊断为阑尾腺癌。原发性阑尾腺癌临床少见,约占阑尾切除标本的0·08%~0·113%,临床表现为阑尾炎或并发症的症状,大约90%阑尾腺癌的患者被误诊为急性阑尾炎[1]。分析误诊原因如下:…     

开放性阑尾切除术与腹腔镜下阑尾切除术的对比分析

目的探究开放性阑尾切除术与腹腔镜下阑尾切除术的应用价值。方法选取我院2017年10月～2018年10月行手术治疗的阑尾炎患者96例,根据手术方法不同分为腹腔镜组和开放组各48例。腹腔镜组行腹腔镜下阑尾切除术,开放组行开放性阑尾切除术,比较两组手术相关指标及手术创伤程度相关指标[降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平]、术后并发症。结果腹腔镜组术中出血量低于开放组,术后住院天数短于开放组(P<0.05);两组术后24h PCT、CRP、IL-6水平均有所升高,但腹腔镜组低于开放组(P<0.05);腹腔镜组术后并发症发生率4.17%(2/48)低于开放组18.75%(9/48)(P<0.05)。结论腹腔镜下阑尾切除术创伤小,能减少术中出血量,促进患者康复,值得临床推广应用。     

临床罕见的子宫血管瘤

52岁。因腹部胀痛、膨隆1年，发现盆腔肿物1天入院。查体：体温36．5℃，脉搏80／min，呼吸20／min，血压120／80mmHg。无贫血貌，心、肺听诊未闻及异常，腹部膨隆，呈孕足月腹型。专科检查：外阴已婚已产式，阴道黏膜无充血，宫颈暴露不清，盆腔内充满肿物，与子宫关系密切，肿物上极达剑突与脐之     

临床少见的髋关节滑膜软骨瘤病

女，32岁。因外伤后右髋部反复疼痛不适2年人院。患者2年前有右髋部摔伤史，此后自觉髋部不适，并进行性加重。曾就诊于多家医院，诊断为外伤性股骨头缺血性坏死，予中药、介入等治疗，效果不佳。查体：跛行，右下肢肌肉萎缩，腹股沟中点压痛，右髋关节活动明显受限。“4”字征阳性。摄X线髋部片示：右     

临床少见的水源性荨麻疹

1　病例资料【例1】　女,17岁。主因接触水后出现皮疹3年,伴痒感,因复发来我院就诊。患者近3年在日常生活中洗脸、洗澡、洗手约5～10分钟后,立即在颜面、躯干、四肢等接触水的部位出现以毛囊为中心的小风团,伴痒感,一般半小时皮疹可自行消退。患者饮水不出现口腔粘膜水肿、腹泻     

Diverticulosis of the appendix: radiographic and clinical features

We have reported three cases of appendiceal diverticulosis diagnosed by barium enema examination, and reviewed the radiographic and clinical findings. An awareness of this lesion is important, since diverticulitis of the appendix may occur in up to two thirds of patients with DA.     

Mucocele of the appendix: an important clinical rarity

Mucocele is an uncommon pathology of the vermiform appendix that can be confused with acute appendicitis. We present a case of an appendiceal mucocele associated with subacute, intermittent right lower quadrant discomfort. The diagnosis of appendiceal mucocele is an important one in that it can be associated with malignancies and other serious gastrointestinal, ovarian, and urological complications.     

Hepatitis in clinical practice

Abstract

Objective: This report illustrates the treatment progression of a patient with rapidly decompensating type 2 diabetes. Methods: The patient had to transition to insulin therapy within 2 years of her initial diagnosis, following only a brief period of glycemic control with diet management, weight loss, and oral agents. This relatively rapid progression to insulin requirement is occasionally seen in adults with typical type 2 diabetes that may classify as a number of different subtypes of diabetes. Results: The case presented demonstrates how a simple stepwise approach to dose titration with basal insulin helped a patient with severe depletion of endogenous insulin achieve initial glycemic control, and how the addition of prandial insulin helped control her mealtime glycemic excursions. Conclusion: The use of basal-prandial insulin therapy is an effective option for patients with rapidly decompensating type 2 diabetes to achieve their glycemic goals without delays and to minimize associated morbidities.     

Plasmapheresis in clinical practice

The authors presented their experience of the use of intermittent plasmapheresis in 220 children with bacterial-inflammatory and immune-mediated diseases characterized by extreme severity and refractoriness to common therapeutic methods. Its use against a background of adequate etiological and pathogenetic therapy was shown to improve therapeutic results. In virus hepatitis with liver insufficiency, bullous erythema and hemorrhagic vasculitis plasmapheresis can be used as an independent method. Differentiated programs of the use of plasmapheresis were proposed, its safety was shown.