脾淀粉样变性并自发性破裂1例

患男性，56岁，因左上腹痛2d伴头昏、心慌入院。无外伤史。既往无肝炎、结核、疟疾病史。查体：BP100/72mmHg，急性失血貌，浅表淋巴结无肿大，皮肤巩膜无黄染，心、肺(-)。腹胀明显，无腹壁浅静脉曲张，左上腹压痛，轻度反跳痛及肌紧张。肝肋下未及，脾大，AB线8cm，AC线9cm，DE线1．0cm，边界欠清，叩痛明显，移浊( )。血     

分叶脾自发性脾破裂1例

分叶脾自发性脾破裂１例杨富林，程欣民，张海蛟（湖南省长沙铁路医院长沙４１０００１）我们于１９９１年１０月收治１例经ＣＴ、手术、病理证实为分叶脾自发性脾破裂延迟出血，病程长达９个月，先后出血４次，尚属罕见，报告如下。患者男，７１岁。无肝炎、肝硬化、疟疾...     

自发性脾动脉破裂1例

腹腔内或腹膜后血管白发性破裂引起的腹腔内大出血称腹部卒中（abdominal apoplexy）,是少见的急腹症。自发性脾动脉破裂是其中一种罕见类型,诊断闻难。剖腹探食手术是有效的诊断及治疗手段。     

自发性脾破裂3例

1　病例报告例 1　女 ,36岁。因持续性左上腹痛 1 2ｈ急诊入院。否认有外伤史。体查 :体温 37 2℃ ,脉搏 1 2 2次 /ｍｉｎ ,呼吸 2 4次 /ｍｉｎ ,血压 80 /55ｍｍＨｇ。贫血貌。心肺未发现异常。有轻度腹肌紧张 ,压痛及反跳痛。Ｂ超检查提示脾破裂。血红蛋白85ｇ/Ｌ ,白细胞 1 3 0× 1 0 9/Ｌ ,中性粒细胞 0 85。腹腔穿刺抽出不凝血。诊断 :自发性脾破裂 ,失血性休克。行剖腹探查术 ,术中见腹腔内有积血约 1 50 0ｍｌ ,双侧盆腔筋膜有大片状出血 ,尤以左侧为甚。脾脏上极破裂约 2ｃｍ× 1ｃｍ× 1ｃｍ大小 ,遂行脾切除术 ,痊愈出院。术后诊…     

脾原发性恶性淋巴瘤并自发性脾破裂一例报告

患者 :男 ,36岁。因左上腹隐胀痛伴乏力、发热 1月入院。入院前 1月感左上腹隐胀痛 ,深吸气时明显 ,疼痛向左肩部放射。伴乏力、不规律发热 ,体温 38℃左右。病程中有左季肋部剧烈疼痛史 ,体重下降 6公斤 ,二便正常。既往无疟疾、肝病病史 ,无外伤史。查体 :无黄疸 ,全身浅表淋巴结无肿大。左上腹略饱满 ,腹软 ,脾肿大于左锁骨中线肋缘下 5ｃｍ ,质硬、固定、轻触痛 ,作者单位 :6610 0 0　云南省个旧市人民医院普外科脾迹消失 ,脾区叩痛阳性 ,无腹水征。血常规 :ＷＢＣ 12 .1× 10 9/Ｌ ,Ｎ 0 .70 ,Ｌ0 .176 ,Ｂ型超声 :脾肿大 16 .7ｃｍ× …     

膀胱淀粉样变性1例

患者 ,女 ,38岁。因全程无痛性肉眼血尿 1年余于 2 0 0 0年 6月 5日入我院。病程中无脓尿、发热和尿路刺激征 ,经止血剂等对症治疗后症状消失 ,但易反复发作。入院后作膀胱 B超在膀胱三角区和底部见 1 0 mm× 6mm× 1 6mm乳头状突起 ,形状不规则 ,表面高低不平 ,且不随体位改变而移动。IVU提示双肾功能和形态正常 ,左输尿管下段梗阻 ,膀胱壁粗糙。膀胱镜检查 ,膀胱三角区和底部见多处直径 5～ 2 0 mm不等的圆形隆起 ,部分隆起之间稍有融合 ,其表面粘膜粗糙并有糜烂。双侧输尿管口均被累及 ,左侧输尿管口则被病变包绕。行新生物活检 ,粘膜…     

尿道淀粉样变性1例报告并系统文献复习

目的总结尿道淀粉样变性(UA)的诊治经验,提高该病的诊疗水平。方法报道我院收治的1例UA患者,系统复习国内外相关文献,进行归纳和总结。结果 61岁男性患者,因排尿困难1年,加重3天就诊,尿道镜活检提示良性病变,剪开前尿道后于球部行人工尿道下裂术,术后病理确诊为尿道淀粉样变性,随访6个月,无复发。结论 UA为一种罕见的良性病变,根据临床表现常难以区分良、恶性,诊断依靠病理,并常需特殊染色。目前治疗意见尚不统一,应根据病程长短、患者症状、病变部位和程度、狭窄段长度等综合选择。     

自发性脾破裂

自发性脾破裂是指无明确外伤史而发生的脾脏突发性或隐匿性破裂,由Atkinson于1874年首先描述。因本病少见,临床诊断困难,误诊率较高,以致延误治疗,故应引起临床足够重视。一、病因及发病机制自发性脾破裂少见,占全部脾破裂的3%~4%,主要发生于病理性脾脏,极少发生于正常脾脏。查阅1994年至2004年国内有关自发性脾破裂文献33篇共111例,发现病理性脾破裂101例(占91%)。病理性脾脏常由传染性疾病、脾占位性疾病、血液性疾病及结缔组织病所致,如慢性病毒性肝炎、血吸虫病、疟疾、伤寒、传染性单核细胞增多症、白血病、恶性淋巴瘤、脾囊肿、脾血…     

腓肠肌自发断裂1例

1病例资料 患者,女,45岁。于2006年5月2日急诊入院。患者诉入院前3h散步时突然感右小腿似被石块击伤样剧痛,休息片刻疼痛减轻即回家,发现局部开始肿胀,疼痛加重不能行走。体检：右小腿高度肿胀,较对侧增粗约8cm;局部压痛显著,尤以腓肠肌近侧明显,肿胀处扪及波动,穿刺抽出血性液体;足背动脉搏动弱,肢端血运好。     

A case of spontaneous esophageal rupture treated with esophagectomy

Although the rupture of the esophagus is frequently a catastrophic event leading to lethal consequences, the mortality and morbidity rate can be significantly lessened by early diagnosis and nutritional management. Early recognition and intensive treatment of this condition are essential and life saving. Multiple techniques, often complex, are necessary to treat the disease, especially when the diagnosis is delayed. A 52-year-old women suffered from severe back pain after vomiting during breakfast, and was admitted to our hospital. Next morning bilateral massive pleural effusion was recognized, and chest drainage tubes were inserted into the bilateral pleural cavity. Three days after admission, drainage fluid changed to be mucous and dark green. Esophagography with Gastrografin demonstrated leakage from right wall of the lower esophagus. A right thoracotomy was performed 83 hours after the onset. In the lower esophagus, there was a longitudinal tear 3 cm in length and the mediastinum was significantly inflamed. So we decided to perform esophagectomy and esophagogastrostomy through ante-thoracic wall route. The right pleural cavity was debrided and thoroughly irrigated with saline. After chest drain removal, right hemothorax occurred in the postoperative period, but she had good recovery and was discharged from our hospital 2 months after the esophagectomy.     

A case of spontaneous rupture of the esophagus

Spontaneous rupture of the esophagus is rare. It's initial symptoms are so varied that we often have a hard time for making early diagnosis of esophageal rupture. In this case, emergency surgery was performed immediately after early diagnosis by chest CT. When the left thoracotomy was done, the upper portion of the stomach protruded with it's mucous membrane was reflected outward into the thoracic cavity above the diaphragm. When the reflected stomach was drawn back into the abdominal cavity for replacement, a ruptured wound of about 5 cm was observed on the left wall of the esophagus above the diaphragm. The stomach was seen protruded from this ruptured wound of the esophagus, with the mucous membrane reflected outward. No pathological abnormalities of esophagus itself was detected even after through investigation to search the cause for this clinically manifested weakness of the esophageal wall which eventually ruptured causing protrusion of the upper portion of the stomach into the thoracic cavity. The mechanism of this gastric protrusion is difficult to define. The most informative diagnostic investigation was the chest CT.