中西医结合治疗急性阑尾炎98例报告

自１９９１年１月至１９９８年１２月,我们采用中西医结合的方法,治疗急性阑尾炎９８例,效果较好,现报告如下。１　临床资料１．１　诊断与治愈标准：本组病例均符合１９８７年总后卫生部颁发的《临床疾病诊断依据治愈好转标准》中有关规定。１．２　一般资料：观察组９８例,其中男７７例,女２１例;年龄６～６２岁,平均２６岁。发病至就诊时间４～７０ｈ,平均２８ｈ。中度以下发热１７例。白细胞计数及中性粒细胞增高９２例。临床分型：急性单纯性阑尾炎６３例,急性化脓性阑尾炎３１例,急性坏疽性阑尾炎４例。对照组６５例为随机…     

惠尔血治疗他巴唑引起急性粒细胞缺乏一例

他巴唑引起急性粒细胞缺乏已有许多报道 ,以往治疗方法常采用激素、抗生素、输注白细胞等 ,随着惠尔血等刺激白细胞生成药物的面世 ,有助于提高粒细胞缺乏的治愈率及减少死亡率。现就我科使用惠尔血治疗他巴唑所致急性粒细胞缺乏一例的较好疗效报告如下。病例 :患者女性 ,45岁 ,因心悸、怕热、消瘦 2月行甲状腺功能检查 ,T3 、T4明显升高 ,TSH降低 ,诊断为 Grave病 ,于 1 994- 1 1 - 2 2起口服他巴唑 1 0mg,3/d,服药 30 d后出现发热、咽痛 ,查血象白细胞 2 .9× 1 0 9/L,中性 0 .5 4 ,淋巴 0 .35 ,即日停药 ,但白细胞仍进行性下降 ,1 2月…     

军人外科急腹症147例临床分析

1995— 1999年我科共收治以“外科急腹症”诊断入院的军人 14 7人 ,年龄 18～ 32岁 ,平均年龄 2 2 4岁。现将有关资料分析报告如下。1　临床资料1 1　急性阑尾炎　 12 4例 ,具有转移性右下腹痛 98例 ,右腹痛 2 0例 ,全腹痛 6例、伴恶心、呕吐 10 8例 ,发热 4 2例 ,麦氏点压痛 98例 ,腹肌紧张 2 1例 ,手术治疗 10 3例。术后病理 :急性蜂窝织炎性阑尾炎 4 5例 ,浅表性阑尾炎 37例 ,坏疽性阑尾炎 2 1例 ,无阑尾周围脓肿形成。1 2　消化道穿孔　 12例 ,军龄 8月～ 1 5年 ,平均军龄为1 2年 ,穿孔到就诊时间为 4～ 13ｈ ,平均为 6 7ｈ。均为空腹…     

未成年人与成人急性阑尾炎的临床及CT表现对照研究

目的探讨未成年人急性阑尾炎(MAA)与成人急性阑尾炎(AAA)的临床及CT表现的异同。方法回顾性分析经手术及病理证实的147例MAA与112例AAA的临床症状、体征、实验室检查、病理及双源CT表现特点,比较两者的异同。结果 MAA与AAA在白细胞计数,是否有发热、呕吐和腹部肌紧张,急性阑尾炎类型,阑尾的显示,有无阑尾增粗、腔内粪石、周围脂肪密度增高、周围脓肿、肠系膜淋巴结增大、腹腔或盆腔积液上差异有统计学意义(P0.05);而在男女比例,中性粒细胞百分比,有无腹痛、压痛、反跳痛、回盲部肠壁肿胀、腹膜增厚、阑尾腔内积气积液及腔外气体上差异无统计学意义(P0.05)。结论 MAA相对AAA有更重的全身症状和体征,其阑尾在CT图像上显示率低,但更易出现阑尾粪石、阑尾周围脓肿、肠系膜淋巴结增大以及腹腔或盆腔积液。     

支气管平滑肌瘤一例

患者女,51岁,1年前无明显诱因出现咯白色黏液痰,不易咯出,晨起夜间较重.外院诊断支气管炎,予抗感染治疗无效.患者近10 d出现活动后气短,于2009年3月25日就诊.病后无发热、胸闷、胸痛,无咯血.10年前曾行子宫肌瘤切除术.体检:呼吸系统未见明显阳性体征.实验窒检查:血白细胞4.16×109/L,中性粒细胞0.52;血生化未见异常;肿瘤标志物正常;肺功能示残气/肺总量百分比增高,弥散功能障碍.     

腹型癫误诊为急性阑尾炎1例

1病例报告患者女,20岁。因右下腹疼痛不适2天就诊。曾在乡卫生院诊断为急性阑尾炎,给予抗感染、镇痛等治疗,效果欠佳,腹痛症状逐渐加重。门诊血常规检查：白细胞11.5×109/L,中性粒细胞0.688。心电图检查：窦性心律,无异常。腹部超声检查：肝、胆、脾、胰、肾、子宫、膀胱声像图未见占位。遂以急性阑尾炎收治入院。查体：右下腹压痛明显,无反跳痛、肌紧张,结肠充气试验、腰大肌试验、闭孔內肌试验均显示阴性。     

少见的泌尿生殖系疾病误为急腹症4例报告

一、先天性孤立肾积水合并感染误为阑尾炎例1女，27岁。因右腹部疼痛1d，于1985年12月16日在当地就诊。据当地医院病历记录：腹部右侧饱满，右肾区叩痛。血红蛋白72g／L，白细胞12.9×109／L，中性0．89。尿常规：蛋白，红细胞+，白细胞，脏球；右下腹穿刺抽出淡黄色液体6ml，镇检：红细胞什、白细胞十。诊为阑尾炎而手术。术中见阑尾无病变，右肾增大积水。行阑尾切除，肾造疾术。术后26d拔除造瘘管出院。但出院1周；腹痛再现并伴有腹决、尿少后转入我院。经B超。膀眈镜检及排泄性、逆行尿路造影，诊断为右先夭性孤立肾积水合并感染，肾…     

重组人粒细胞集落刺激因子在小儿急性淋巴细胞白血病化疗中的应用

 目的观察在小儿急性淋巴细胞性白血病(ALL)强烈化疗后应用重组人粒细胞集落刺激因子(rhG-CSF)的辅助治疗作用.方法26例ALL患儿在进行强烈化疗时随机分为rhG-CSF治疗组和对照组,观察两组患者白细胞、中性粒细胞降低时间及感染发生率的变化.结果与对照组相比强烈化疗后治疗组患儿白细胞、中性粒细胞降低时间明显缩短(t=2.51,P＜0.01),感染发生率明显降低,发热时间明显缩短.结论在强烈化疗后应用rhG-CSF可保证强烈化疗方案的顺利进行,提高化疗的疗效.     

急性阑尾炎的B超诊断探讨(附50例分析)

急性阑尾炎为最常见的急腹症 ,正常阑尾超声检查多难以显示 ,但阑尾炎性肿大明显或有积液 ,超声亦能发现病变阑尾的图像。本文通过对急性腹痛病人在B超探查时 ,腹部声像图异常表现而疑诊为急性阑尾炎的病例 ,经与临床资料对比证实为急性阑尾炎的 5 0例 ,分析探讨 ,旨在提高B超对本病的诊断水平。1　材料与方法　　搜集我院 2 0 0 0年 1月～ 2 0 0 2年 1月间因腹痛或转移性右下腹痛 ,伴恶心呕吐、发热病人经B超检查诊断为急性阑尾炎的病例 5 0例 ,其中男 35例 ,女 15例 ,年龄 17～ 70岁。手术证实 38例 ,临床保守治疗后确诊 11例 ,误诊 1例…     

沙利度胺治疗重度疱疹型阿弗他溃疡1例

1病例报告患者男,35岁。因发热伴咽痛1天就诊。查体：体温39.5℃,咽部多发小溃疡。血常规检查：白细胞13.2×109/L,中性粒细胞0.85。考虑上呼吸道感染,给予头孢美唑等治疗。1周后发热消退,白细胞降至正常水平。     

Ultrasound in pediatric patients with suspected acute appendicitis: Value in establishing alternative diagnoses

The objective of this study was to investigate the value of ultrasound to establish alternative diagnoses in pediatric patients with clinical suspicion of acute appendicitis. A total of 206 consecutive patients with right lower abdominal pain were evaluated by ultrasound. For each case, the sonographic findings documented on the report at the time of examination were compared with the final diagnosis.Our results demonstrated that ultrasound was 94% accurate in the diagnosis of acute appendicitis. Among all 42 of the 108 truenegative cases of appendicitis, there was a variety of sonographic findings other than appendiceal abnormality, comprising intestinal and/or mesenteric, gallbladder, and ovarian abnormalities. Sonographic findings were well correlated with clinical and/or surgical diagnoses. Only 3 of these 42 cases were treated by surgical intervention.Ultrasound of pediatric right lower abdominal pain is a reliable diagnostic tool not only for appendicitis but for alternative diagnoses mimicking appendicitis.     

急性阑尾炎的临床诊治（附56例分析）

目的：探讨急性阑尾炎患者的患病因素,临床表现特点和治疗方法。方法：对2004-03～2010-03住院的56例患者的临床资料进行回顾性分析。结果：急性阑尾炎与阑尾管腔阻塞,胃肠道疾病影响,细菌入侵等因素密切相关。此外,与全身抵抗力下降也有一定关系。56例急性阑尾炎均表现为腹痛,恶心,呕吐胃肠道症状,头痛、畏寒、发热等全身症状。经查体有右下腹固定压痛点,腹膜刺激征,联合应用B型超声检查,血常规等检查有助于诊断。结论：急性阑尾炎近年发病率呈增加趋势,且病情急,变化快,应早发现,早确诊,早治疗,以减少并发症。     

CT of appendicitis in children

Appendicitis is the most common condition requiring intraabdominal surgery in infancy and childhood. Yet, despite its common occurrence, accurate diagnosis remains challenging. Acute appendicitis may be missed at initial clinical examination in 28%-57% of children aged 12 years and younger and in nearly 100% of children under the age of 2 years. Diagnostic imaging has an ever-increasing role in the prompt and accurate diagnosis of acute appendicitis in the pediatric population. At the authors' institution, helical computed tomography (CT) is the primary tool for diagnosing or excluding appendicitis in children. Since its inception in 1998, helical CT with rectally administered contrast material has been shown to reduce the total number of inpatient observation days, laparotomies with negative findings, and per-patient cost. Helical CT is a highly sensitive and specific tool for diagnosing pediatric appendicitis and has resulted in a beneficial change in patient care in 68.5% of all patients seen in the authors' emergency department for suspected appendicitis. This includes both those patients who receive an eventual diagnosis of appendicitis and those who do not have the disease. Major strengths of limited helical CT with rectal contrast material include producing uniformly high published sensitivity and specificity values for diagnosis of appendicitis and enabling diagnosis of alternative conditions of acute abdominal pain in children. In contrast, limitations of graded-compression ultrasonography in children include highly operator-dependent sensitivity and specificity values and relative infrequency with which the normal appendix can be visualized in this population. Although there have been many exciting diagnostic advancements for the diagnosis of acute appendicitis in the pediatric population, the role of helical CT is far from clear. The purpose of this article is to describe a helical CT approach to imaging in children suspected of having acute appendicitis at a large urban pediatric teaching hospital and its effects on patient outcomes and hospital costs.     

高龄阑尾炎病情严重程度诊断分析

目的探讨与比较老年急性单纯性阑尾炎与急性化脓性阑尾炎、坏疽阑尾炎或伴穿孔的发病特点、诊断要点、治疗方法选择。方法选取近10年我院符合急诊初诊为急性阑尾炎,年龄在70岁以上的高龄患者,共79例,按照标准,根据炎性反应轻重分两组,从术前症状、体征、相关检验、检查进行统计学比较。结果 77例为非手术治疗或手术治疗后急性阑尾炎痊愈患者,行手术治疗患者,经病理证实诊断明确;2例为回盲部肿瘤患者,手术病理明确诊断。结论体温升高、右下腹反跳痛、超声诊断对于区分高龄阑尾炎严重程度具有较大意义,转移性右下腹痛和血象升高也有一定参考意义。同时应当注意同回盲部肿瘤相鉴别。     

Case report: ultrasonographic demonstration of portal vein thrombosis in the acute abdomen

Ultrasonography demonstrated thrombus within the portal venous system in a child who presented with abdominal pain and a fever. This helped lead to a diagnosis of appendicitis complicated by ascending septic thrombophlebitis. Ultrasound of the portal vein may be of value when investigating such children with atyptical abdominal pain.     

Appendiceal hyperemia and/or distention is not always appendicitis: appendicitis mimicry in the pediatric population

Appendicitis is the most common surgical cause of acute abdominal pain in the pediatric population. Several conditions can mimic the clinical presentation of appendicitis, leaving imaging as an essential modality to uncover the etiology, yet under certain circumstances, it can be misleading. Here, we present three cases where findings on multidetector computerized tomography scans supported the diagnosis of appendicitis, yet an alternate cause was found. These cases highlight a particular pitfall of satisfaction of search.     

Appendicitis in children: color Doppler sonography.

The authors used color Doppler ultrasonography (US) to evaluate 33 children with suspected appendicitis and found locally increased blood flow in all of 10 patients with appendicitis or periappendiceal abscess; the studies were normal in 16 patients without appendicitis. The gray-scale sonographic results were concordant in all 26 of these patients. In two other patients with presumptive mesenteric adenitis and in one patient with a hemorrhagic ovarian cyst at gray-scale US, color Doppler imaging showed no increased perfusion and aided in confirming the absence of a significant inflammatory process. In four other children, color Doppler US clarified gray-scale sonographic findings that might have been confused with complicated appendicitis and aided in the diagnosis of other causes of acute abdominal pain. These findings indicate that color Doppler US is a useful adjunct to gray-scale US in evaluating children with suspected acute appendicitis.     

Abdominal pain: general imaging strategies

Acute abdominal pain is the most common condition necessitating surgical admission to a paediatric hospital. The vast majority of cases are due to either appendicitis or acute non-specific abdominal pain; however, there are many other conditions presenting with acute abdominal pain in childhood which can mimic appendicitis. Some of these conditions are rarely encountered in adult practice. Plain abdominal radiographs are still obtained initially on many children presenting with abdominal pain. In the absence of associated symptoms such as vomiting however, ultrasonography (US) is more likely to elucidate the underlying cause of pain than plain-film radiography. While computed tomography (CT) is being used extensively in investigating adults with abdominal pain, its widespread use in children is to be avoided in the interest of radiation protection.     

Abdominal pain: general imaging strategies

Acute abdominal pain is the most common condition necessitating surgical admission to a paediatric hospital. The vast majority of cases are due to either appendicitis or acute non-specific abdominal pain; however, there are many other conditions presenting with acute abdominal pain in childhood which can mimic appendicitis. Some of these conditions are rarely encountered in adult practice. Plain abdominal radiographs are still obtained initially on many children presenting with abdominal pain. In the absence of associated symptoms such as vomiting however, ultrasonography (US) is more likely to elucidate the underlying cause of pain than plain-film radiography. While computed tomography (CT) is being used extensively in investigating adults with abdominal pain, its widespread use in children is to be avoided in the interest of radiation protection.     

Omental infarction in pediatric patients: sonographic and CT findings

OBJECTIVE: Children with omental infarction typically present with abdominal pain and are diagnosed clinically as having acute appendicitis. Our purpose was to perform a retrospective review of the imaging findings in nine children with omental infarction as an aid to radiologists in distinguishing this entity from acute appendicitis. CONCLUSION: In pediatric patients with omental infarction, both CT and sonography show a heterogeneous mass characteristically situated between the anterior abdominal wall and the colon. It is important for radiologists to recognize the characteristic imaging findings seen with omental infarction.