诊断性腹腔穿刺在腹腔脏器损伤中的应用

Objective To discuss the clinic value of diagnostic abdominal paracentesis in traumas of abdominal organ. Method Retrospective analyze 105 cases of abdominal trauma that performed diagnostic abdominal paracentesis. Result 88 cases had positive findings at first time (83.8%), and 9 cases and positive findings at the second time (8.6%).So it has a positive ratio of 92.4% in all. Conclusion Diagnostic abdominal paracentesis is a easy, rapid, accurate method for diagnosis of trauma in abdominal organ, and have some practical value.     

胃癌急性穿孔手术治疗临床分析

目的 探讨胃癌穿孔患者的临床特点、诊断方法及手术方式.方法 回顾性分析我院收治的27例胃癌并发急性胃穿孔患者的临床资料及手术方式.结果 27例患者均行手术治疗,其中治愈25例,死亡2例,死于感染性休克伴多脏器功能衰竭.术后并发切口感染4例,消化道出血1例.结论 手术切除可最大限度地减少晚期癌肿所带来的多种并发症如出血、癌肿疼痛、修补后再穿孔等,使患者生存质量均得到明显提高,取得了良好效果.

Abstract：

Objective To investigate the clinical features, diagnosis and operative manner of acute perforation of gastric cancer. Methods The clinical data and operative manners of 27 patients with perforated gastric cancer were retrospectively analyzed. Results Twenty-five cases were cured and 2 cases died of septic shock accompanied with multiple organ dysfunction syndrome. Postoperative wound infection occurred in 4 cases and hemorrhage of digestive tract occurred in 1 case. Conclusion Early diagnosis and selecting exactly surgical methods are the important factors of decreasing the death rate and increasing life quality in acute perforation of gastric cancer.     

3种药物治疗妊娠中期外阴阴道假丝酵母菌病的疗效比较

Objective To observe the clinical therapeutic effect of the treatment on vulvovaginal candidiasis (VVC) in the mid trimester of pregnancy with three species of drug (Clotrimazole,Macmirorcomplex, Baofukang Shuan). Methods 83 women diagnosed with VVC in the mid trimester of pregnancy were divided into three groups: Group A with 30 cases, treated with Clotrimazole for twice; Group B with 28 cases, treated with Macmirorcomplex for 6 days; Group C with 25 cases, treated with Baofukang Shuan for 8 days. Observed the clinical effect, the microbes therapeutic effect and the adverse effect of the treatment with three species of drug. Results (1)The clinical cure rate of Group A was 86.67% and the fungal negative rate was 93.33%. The clinical cure rate of Group B was 57.14% and the fungal negative rate was 75%. The clinical cure rate of Group C was 60% and the fungal negative rate was 40%. There were no adverse effect to be found in the three groups. (2) The clinical cure rate and curative rate of Group A were significantly higher than those of Group B and Group C( P＜0,05 ),but there were no difference in Group B and Group C ( P＞ 0.05 ). The V VC scores of the three groups were significantly descended compared with those of pretherapy ( P＜ 0.01 ), but there were no difference of the curative rate about microbes therapeutic effect in the three groups ( P＞ 0.05 ).Conclusion The three drugs for VVC in pregnancy are all effective and no serious adverse effect. Clotrimazole has better clinical therapeutic effect than Macmirorcomplex and Baofukang Shuan.     

急性肺血栓栓塞症临床分析

目的 分析探讨肺血栓栓塞症的临床特点,提高诊治水平.方法 对郑州大学第五附属医院2006年1月至2010年12月确诊的38例急性肺栓塞患者的临床资料进行回顾性分析.结果 38例急性肺栓塞患者发生肺栓塞的危险因素有高龄、下肢深静脉血栓形成、冠心病、骨折或手术后、恶性肿瘤等;患者的主要临床表现为呼吸困难、胸痛、咳嗽、心悸及下肢不对称性肿胀;血气分析表现为低氧血症(34/38),血浆D-二聚体阳性率达95%(36/38),胸部X线片主要表现为肺部浸润影(7/38)和胸腔积液(4/38),心电图主要表现为窦性心动过速(24/38)和非特异性ST-T改变(8/38),超声心动图显示肺动脉高压(22/38),所有患者均经肺动脉CT造影确诊,首诊误诊率达47.4%.其中单纯抗凝治疗20例,溶栓+抗凝治疗18例,疗效差异无统计学意义[70.0%(14/20)比72.2%(13/18),P＞0.05].溶栓+抗凝治疗组较单纯抗凝组出血发生率高[27.8%(5/18)比5.0%(1/20),P＜0.05],但均未出现发生致命性出血者.结论 肺栓塞的发病与易患因素密切相关,肺栓塞的临床症状体征不典型,需结合辅助检查进行诊断.溶栓治疗及抗凝治疗同样有效,肺栓塞的误诊率高,应提高诊断意识和诊断水平.

Abstract：

Objective To explore the clinical character of acute pulmonary thromboembolism to improve the diagnosis and treatment of the disease. Methods Clinical data of 38 cases of acute pulmonary thromboembolism from 2006 to 2010 were analyzed retrospectively. Results Eldly, deep vein thromboembolism of crura, coronary heart disease, fracture, surgery and cancer were the most common risk factors with 38 cases of acute pulmonary thromboembolism. the common symptoms were dyspnea, chest pain, cough,palpitation and asymmetric edema of the lower extremities; the arterial blood gas in 34 cases showed hypoxemia. The positive rate of blood D-dimer elevation was 95% (36/38). The main signs in chest X-ray were infiltrates (7/38) and pleural effusions (4/38). Nonspecific ST-T changes (8/38) and sinus tachycardia(24/38) were the most common abnormalities in electrocardiogram. Twenty-two cases showed pulmonary artery hypertension on echocardiogram. All cases were diagnosed through CT pulmonary angiography. The misdiagnosis rate was 47.4% at the first diagnosis.Twenty cases received anticoagulant therapy and 18 cases received thrombolytic therapy, curative effect wasn't different in statistics (P＞0.05), the bleeding rate of thrombolytic therapy group was higher than that of anticoagulant therapy group[27. 8% (5/18) vs 5.0% (1/20) ,P＜0.05] and no case of lethality haemorrhage was found. Conclusions The incidence of pulmonary embolism is closely related to the associated factors. Clinical symptoms and signs of pulmonary embolism are atypical. The role of clinical assessment is important. Anticoagulant therapy is as effective as thrombolytic therapy.     

可重复使用痔吻合器行PPH术术后并发症的处理对策

Objective To analyze the reasons of postoperative complications of procedure for prolapse and hemorrhoids with reusable hemorrhoid stapler and evaluate the countermeasure of preventive handle.Methods To retrospectively analyze the clinical data and postoperative complications of 107 cases hemorrhoid patients treated with PPH from January 2006 to December 2008 in our department,at the same time to analyze and summarize the reasons of postoperative complications of procedure for prolapse and hemorrhoids and countermeasure to handle.Results The average operation time was 14 rain.The Average resident date was 4 days.The short-term postoperative complications include:32 cases anus uncomfortable(30.0%),25 cases anus severe pain(23.4%),19 cases urinary retention(17.8%),6 cases remain cutaneous tag(5.6%),5 cases rectal tenesmus(4.6%).Postoperative bleeding was not found in any case.A few patients feel abdominal discomfort and perineal region discomfort,which relieve in progress without any privilege,Long-term postoperative complications include 2 cases stoma stenostomia(1.9%),take a favorable turn by enlarging anus.After follow-up 5～36 months,anus infection,copracrasia,palindromia and rectovaginal fistula were not found in any case.Conclusion Reusable hemorrhoid staplers are satisfactory when using in the PPH.The stapler could he used repeatedly and cost less.Thus,they are acceptable and worthy to promote.     

危重症患者血清降钙素原测定对细菌感染的诊断价值

Objective To evaluate the clinical value of serum procalcitonin (PCT) in the diagnosis of bacte-rial infections in the critically ill patients. Methods A loud d 100 cases of critical patients were divided into bacteri-al infection group(56 cases) and non-bacterial infection group(44 cases). Serum PCT was measured by immunolu-minometric assay. Results The concentration of PCT in bacterial infection group(21.54 ±5.72) μg/L, was signifi-cantly higher than non-bacterial infection group (11. 95±4. 58)μg/L (t =2.291,P<0.05);The APACHE Ⅲ score of bacterial infection group(62. 44 ± 19. 55) cent was significantly higher than non-bacterial infection group(44. 56 ± 25. 88) cent(t = 2. 195 ,P < 0. 05). The concentration of PCT of 1.0μg/L and 2. 0 p.g/L compared to the former sensitivity (96. 5) % higher than the latter (55.2) % (X2 = 3. 94, P < 0. 05), the former specificity (41.7) % lower than the latter (95.8)% (X2 = 4. 02 ,P < 0. 05);1.5μg/L as a positive standard Youden index and the Agreement (83.0 % ,0. 65), were significantly higher than 1 μg/L and 2 μg/L(71.7%, 0. 38 ;73.6% ,0. 51) (X2 = 3.84, X2=3. 90,X2 = 3.992 = 3.91 ,P < 0. 05);The concentration of PCT in death group (38. 9 ±12. 6)μg/L was signifi-canfly higher than the survival group(11.8± 8. 3) μg/L(t =2. 398 ,P <0. 05). Conclusion Serum PCT has clinical values in the diagnosis and therapy of bacterial infections in the critical patients.     

危重症患者血清降钙素原测定对细菌感染的诊断价值

Objective To evaluate the clinical value of serum procalcitonin (PCT) in the diagnosis of bacte-rial infections in the critically ill patients. Methods A loud d 100 cases of critical patients were divided into bacteri-al infection group(56 cases) and non-bacterial infection group(44 cases). Serum PCT was measured by immunolu-minometric assay. Results The concentration of PCT in bacterial infection group(21.54 ±5.72) μg/L, was signifi-cantly higher than non-bacterial infection group (11. 95±4. 58)μg/L (t =2.291,P<0.05);The APACHE Ⅲ score of bacterial infection group(62. 44 ± 19. 55) cent was significantly higher than non-bacterial infection group(44. 56 ± 25. 88) cent(t = 2. 195 ,P < 0. 05). The concentration of PCT of 1.0μg/L and 2. 0 p.g/L compared to the former sensitivity (96. 5) % higher than the latter (55.2) % (X2 = 3. 94, P < 0. 05), the former specificity (41.7) % lower than the latter (95.8)% (X2 = 4. 02 ,P < 0. 05);1.5μg/L as a positive standard Youden index and the Agreement (83.0 % ,0. 65), were significantly higher than 1 μg/L and 2 μg/L(71.7%, 0. 38 ;73.6% ,0. 51) (X2 = 3.84, X2=3. 90,X2 = 3.992 = 3.91 ,P < 0. 05);The concentration of PCT in death group (38. 9 ±12. 6)μg/L was signifi-canfly higher than the survival group(11.8± 8. 3) μg/L(t =2. 398 ,P <0. 05). Conclusion Serum PCT has clinical values in the diagnosis and therapy of bacterial infections in the critical patients.     

危重症患者血清降钙素原测定对细菌感染的诊断价值

Objective To evaluate the clinical value of serum procalcitonin (PCT) in the diagnosis of bacte-rial infections in the critically ill patients. Methods A loud d 100 cases of critical patients were divided into bacteri-al infection group(56 cases) and non-bacterial infection group(44 cases). Serum PCT was measured by immunolu-minometric assay. Results The concentration of PCT in bacterial infection group(21.54 ±5.72) μg/L, was signifi-cantly higher than non-bacterial infection group (11. 95±4. 58)μg/L (t =2.291,P<0.05);The APACHE Ⅲ score of bacterial infection group(62. 44 ± 19. 55) cent was significantly higher than non-bacterial infection group(44. 56 ± 25. 88) cent(t = 2. 195 ,P < 0. 05). The concentration of PCT of 1.0μg/L and 2. 0 p.g/L compared to the former sensitivity (96. 5) % higher than the latter (55.2) % (X2 = 3. 94, P < 0. 05), the former specificity (41.7) % lower than the latter (95.8)% (X2 = 4. 02 ,P < 0. 05);1.5μg/L as a positive standard Youden index and the Agreement (83.0 % ,0. 65), were significantly higher than 1 μg/L and 2 μg/L(71.7%, 0. 38 ;73.6% ,0. 51) (X2 = 3.84, X2=3. 90,X2 = 3.992 = 3.91 ,P < 0. 05);The concentration of PCT in death group (38. 9 ±12. 6)μg/L was signifi-canfly higher than the survival group(11.8± 8. 3) μg/L(t =2. 398 ,P <0. 05). Conclusion Serum PCT has clinical values in the diagnosis and therapy of bacterial infections in the critical patients.     

危重症患者血清降钙素原测定对细菌感染的诊断价值

Objective To evaluate the clinical value of serum procalcitonin (PCT) in the diagnosis of bacte-rial infections in the critically ill patients. Methods A loud d 100 cases of critical patients were divided into bacteri-al infection group(56 cases) and non-bacterial infection group(44 cases). Serum PCT was measured by immunolu-minometric assay. Results The concentration of PCT in bacterial infection group(21.54 ±5.72) μg/L, was signifi-cantly higher than non-bacterial infection group (11. 95±4. 58)μg/L (t =2.291,P<0.05);The APACHE Ⅲ score of bacterial infection group(62. 44 ± 19. 55) cent was significantly higher than non-bacterial infection group(44. 56 ± 25. 88) cent(t = 2. 195 ,P < 0. 05). The concentration of PCT of 1.0μg/L and 2. 0 p.g/L compared to the former sensitivity (96. 5) % higher than the latter (55.2) % (X2 = 3. 94, P < 0. 05), the former specificity (41.7) % lower than the latter (95.8)% (X2 = 4. 02 ,P < 0. 05);1.5μg/L as a positive standard Youden index and the Agreement (83.0 % ,0. 65), were significantly higher than 1 μg/L and 2 μg/L(71.7%, 0. 38 ;73.6% ,0. 51) (X2 = 3.84, X2=3. 90,X2 = 3.992 = 3.91 ,P < 0. 05);The concentration of PCT in death group (38. 9 ±12. 6)μg/L was signifi-canfly higher than the survival group(11.8± 8. 3) μg/L(t =2. 398 ,P <0. 05). Conclusion Serum PCT has clinical values in the diagnosis and therapy of bacterial infections in the critical patients.     

CT在胃肠道穿孔诊断中的临床应用价值

目的:评价CT在胃肠道穿孔诊断中的临床应用价值。方法:29例经手术证实的胃肠道穿孔患者术前均行腹部平片和CT扫描检查,分析其表现,比较两种检查方法的诊断结果。结果:29例中腹内游离气体验出率,X线平片为69.0%,CT为89.7%,两种检查方法检出率比较差异有显著性(P<0.05)。术前CT对胃肠道穿孔病因诊断符合率为86.2%。结论:CT在胃、肠道穿孔及其病因和并发症的诊断中有明显优势。     

闭合性腹部损伤49例的早期诊治体会

目的 探讨闭合性腹部损伤的早期诊断方法,提高诊断水平.方法 对49例闭合性腹部损伤的临床资料进行回顾性分析.结果 腹腔穿刺是确诊的主要检查手段,部分患者选择性地做了腹部B超和CT检查,2项诊断检查的阳性率均在90%以上,X线可与B超结合使用以提高阳性率.结论 闭合性腹部损伤早期在全面细致的体格检查后,针对病史选择性进行一些必要的辅助检查,可显著提高临床确诊率.及时手术是降低死亡率的关键.     

消化道穿孔58例临床特点分析

目的分析消化道穿孔的临床特点,提高诊断率。方法回顾分析58例术后确诊为消化道穿孔患者的资料,总结其症状、体征特点及腹部X线,评价各项指标的临床诊断意义。结果58例患者均有不同程度腹部压痛和“板状腹样”体征,典型腹膜刺激征者41例（70．7％）,其中老年人有典型体征者占44．4％（4／9）,中青年组占75．5％（37／49）。79％（46／58）的患者在腹部X线片中发现膈下游离气体。结论消化道穿孔的临床表现不一,病史、体征、X线检查综合诊断是提高诊断率的关键。     

超声诊断消化道穿孔的临床价值

目的探讨超声在消化道穿孔诊断中的临床价值。方法对30例经手术和病理证实为消化道穿孔患者的声像图进行回顾性分析,并与X线检查结果对比、分析。结果超声诊断腹腔积气22例占70%,腹腔积液28例占93.3%,腹腔包块15例占50%,X线-发现腹腔游离气体23例占76.6%。结论超声诊断消化道穿孔优于X线-,提高消化道穿孔早期诊断率,在外科急腹症中具有鉴别诊断价值。     

30例双侧乳腺癌的X线诊断研究

目的分析探究双侧乳腺癌的X线科学诊断。方法对30例双侧乳腺癌患者的X线诊断资料开展回顾性分析。结果 12例患者具有直接征象,18例患者具有间接征象,漏诊、误诊均为5例。结论充分研究X线摄片结果,并参考临床以及触诊情况,对乳腺癌X线征象进一步掌握,提升观察准确性,必要时辅之以乳导管镜、B超以及CT、MRI和局部重点片等检查手段,更加科学地诊断。     

28例小肠间质瘤临床病理特征分析

目的 探讨小肠间质瘤(SIST)临床病理特征,以期指导SIST的早期诊断及预后判断.方法 回顾性分析经普外科及术后病理确诊的SIST病人的一般资料、影像学特征、术后病理等临床资料,依据胃肠间质瘤(GIST)恶性潜能分级标准(改良的NIH标准)进行危险度分级.采用 χ2 检验(Fisher确切概率法)比较高度危险组与中低度危险组临床特征之间的差异.结果共28例SIST入选,男性占60.7%(17/28),女性占39.3%(11/28),平均年龄(50.8±14.9)岁,SIST临床症状缺乏特异性,首发症状有:体检发现腹部包块7例,消化道出血7例,慢性腹痛9例,急性腹痛5例,以空肠、十二指肠、回肠多见.16例高度危险性(57.1%),12例中低度危险性(42.9%),高危组急性腹痛比例明显高于中低危组(P<0.05),中低度危险组出现消化道出血比例明显高于高度危险组(P<0.05),两组年龄、性别、慢性腹痛、腹部包块的比较差异无统计学意义.B超检查对SIST的检出率不高,CT检出率高于B超.高危组CT检出率明显高于中低危组.结论 SIST首发症状以腹部包块、消化道出血、慢性腹痛多见,高度危险性多见,不同恶性程度SIST临床特征及影像学表现存在差异.CT检出率及诊断符合率明显高于B超,SIST首选手术切除,疑诊SIST应及早手术探查.     

腹部超声在急性胰腺炎中的诊断价值

目的探讨腹部超声检查在急性胰腺炎中的诊断价值,利于评估病情、及时准确的治疗。方法选取我院消化内科收治的急性胰腺炎患者86例,进行回顾性分析,并与临床表现、血尿淀粉酶及CT等检查结果进行对比。结果86例胰腺炎患者中超声对急性胰腺炎的诊断符合率为74．4％,与CT诊断阳性率无明显差异,且对腹腔积液诊断的灵敏度高于CT。结论腹部超声在急性胰腺炎诊断上有实用的临床价值,无痛无创、快捷简便,且能评估病情的程度,便于临床治疗。     

腹部闭合性损伤诊治体会(附169例临床分析)

目的 总结腹部闭合伤的诊治体会.方法 回顾性分析我院1998-2006年收治的闭合性腹部创伤169例的临床诊治资料.结果 治愈160例,死亡9例.死亡原因主要为严重的颅脑外伤,多脏器功能衰竭(MODS),失血性休克.结论 腹部创伤诊断仍以腹部症状、体症为主要依据.腹腔穿刺、B超、CT检查对诊断腹部闭合伤的准确率高.而腹腔镜检查已成为腹部外科一项极有价值和前途的诊疗新技术.紧急手术是主要治疗手段,术式应简单、有效.     

阑尾炎X线检查价值分析

目的探讨阑尾炎的X线征象,提高该病的X线诊断水平。方法 86例患者均摄有腹部立位平片,呈慢性发病的16例同时做了全消化道钡餐造影检查,其中4例又做了钡灌肠造影检查。结果腹部立位平片检查急性发病者70例患者中,表现为局限性小肠积气或弥漫性小肠伴大肠积气者63例,表现正常者7例;慢性发病者16例患者中,表现正常者14例,表现为局限性右下腹部第5、6组小肠区积气伴有小液平者2例。16例慢性发病者行造影检查,阑尾充盈显影8例,未显影8例。结论 X线检查不仅可作为阑尾炎诊断中的排他性方法,而且能发现一些异常征象,为临床诊断治疗提供更详细的信息。     

超声诊断腹腔内空腔脏器穿孔的临床应用价值

目的探讨超声在诊断腹腔空腔脏器穿孔中的临床应用价值。方法回顾性分析18例经手术和病理证实的腹腔空腔脏器穿孔患者的超声声像图,并与X线检查结果对照分析,比较两种方法的诊断符合率和腹腔游离气体的检出率。结果术前采用腹部探头及高频探头联合超声检查12例(66.7%)发现腹腔游离气体,且均探及腹腔积液,略高于X-线平片的61.1%(P>0.05)。另7例X-线平片未发现游离气体的患者中有3例(27.8%)超声检查探及腹腔积液,超声检查的总体符合率为83.3%(15/18),而显著高于X-线片的66.7%(P<0.05)。结论超声不仅可发现腹腔空腔脏器穿孔时的游离气体,而且可探及腹腔积液,有助于早期诊断,可作为诊断腹腔空腔脏器穿孔的首选影像学检查方法。