腹腔镜探查在急腹症诊治中的应用

目的 探讨腹腔镜探查在急腹症诊治中的应用效果.方法 对47例实施腹腔镜探查急腹症患者的临床资料进行回顾性分析.结果 全组患者术中均明确诊断,腹腔镜完成诊治45例(95.7％),中转开腹2例(4.3％).手术时间25～105 min,平均43 min;出血量为10～200 mL,均未输血.住院时间为4～16 d,平均7.6 d.均痊愈出院.结论 腹腔镜手术具有较高的诊断价值,比开腹手术痛苦小、住院时间短、并发症少,是普外科急腹症理想的诊治手段.     

急腹症腹腔镜手术25例分析

急腹症急诊腹腔镜手术25例，其中急性胆囊炎胆囊切除术12例，急性阑尾炎阑尾切除术6例，消化性溃疡穿孔穿孔修补术3例，胃大部切除、毕氏Ⅱ式吻合术1例，左侧腹股沟斜疝嵌顿、肠梗阻疝修补术1例，仅1例肠梗阻表现的升结肠癌和1例粘连性肠梗阻转剖腹手术。腹腔镜确诊率为100％，腹腔镜手术成功率为92％。     

Spontaneous Rupture of the Spleen: A Rare but Serious Case of Acute Abdominal Pain in Pregnancy

Background

Spontaneous (non-traumatic) rupture of the spleen rarely occurs in the setting of a normal spleen, especially during pregnancy.

Objectives

We report a case of spontaneous rupture of a normal spleen at 33.7 weeks gestation and review the literature with the aim of exploring the etiology, diagnosis, and management of this condition during pregnancy.

Case Report

A 30-year-old Chinese primigravida presented at 33.7 weeks gestation with acute onset of severe, constant left upper abdominal pain. She developed acute hypotension. Physical examination revealed diffuse abdominal tenderness with rebounding and guarding. An emergent cesarean delivery and abdominal exploration was performed. A non-viable male infant was delivered, and active bleeding was identified at the splenic hilum consistent with splenic rupture. A splenectomy was performed, and a consumptive coagulopathy was identified and treated. The patient had an uncomplicated postoperative course and was discharged home on postoperative day 15.

Conclusion

Splenic rupture in pregnancy is a life-threatening complication. Early diagnosis and aggressive surgical intervention will allow for optimal maternal and perinatal outcome.     

无面部血管瘤的Sturge-Weber综合征一例

目的 分析无面部血管瘤的Sturge-Weber综合征(SWS)的临床特点.方法 2008年10月收治1例女性患儿,8岁,因发作性四肢强直入院,患儿无面部血管瘤及眼部异常,仅表现为癫痫.患儿接受丙戊酸钠抗癫痫治疗.结果 患儿经头部CT、MRI确诊为无面部血管瘤的SWS.抗癫痫治疗后随访12个月,未再发癫痫,智力发育无减...     

HELLP syndrome and cholecystitis: Case report and review of the literature

A case of the HELLP syndrome is reported that was initially diagnosed as cholecystitis. Much overlap exists between the two diagnoses, and the emergency physician must be aware of the important differences between them. Because the HELLP syndrome and preeclampsia may occur in both the second and third trimesters, they represent serious diagnoses that must be considered when evaluating a pregnant patient with right upper quadrant abdominal pain.     

腹腔镜探查术在诊断不明急腹症中的应用体会(附52例报告)

目的 探讨腹腔镜诊治急腹症的价值和治疗经验。方法 回顾性总结52例腹腔镜诊治急腹症的效果。结果 52例经腹腔镜检查全部明确诊断，42例同时完成诊断和治疗，8例无需手术治疗，2例中转开腹。无1例出现并发症和死亡。结论 腹腔镜诊治急腹症具有诊断率高、可信性强、创伤小、恢复快、并发症少等优点，因而具有很好的临床应用价值。     

急性视网膜坏死综合征的早期诊断与治疗

【目的】探讨急性视网膜坏死综合征的早期诊断和治疗方法。【方法】回顾性研究17例18只眼急性视网膜坏死综合征患者的临床表现和治疗措施。【结果】13只眼玻璃体切割联合眼内硅油填充术,术后视网膜复位11只眼(85％),手术治疗后视力提高者7只眼(54％)。早期大剂量无环鸟苷治疗后,单眼发病者未发现对侧眼发病。【结论】尽早应用大剂量的抗病毒药物,结合预防性玻璃体切割术可提高急性视网膜坏死综合征的治疗效果,同时减少了对侧眼的发病率。     

Laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons: A case report

Persistent mesocolon is an embryological anomaly of the colon resulting from failure of the primitive dorsal mesocolon to fuse with the parietal peritoneum. We herein present a case of laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons and a right‐bound inferior mesenteric artery. Preoperative 3‐D CT demonstrated that the sigmoid colon had shifted to the right abdomen and was located under the ascending colon. Moreover, the inferior mesenteric artery and vein traveled toward the right abdomen accompanied by the mesentery of the descending colon. Adhesiolysis between the ascending and sigmoid colon was initially performed, and the sigmoid colon was placed in its normal position. The inferior mesenteric artery was then divided with lymph node dissection using a medial approach, and high anterior resection was completed. An understanding of the anatomical characteristics of persistent mesocolon is important to ensure safe laparoscopic surgery.     

Sturge-Weber综合征的CT与MRI比较影像学研究(附9例报告)

目的 探讨CT与MRI在诊断Sturge-Weber综合征中的价值。方法 收集Sturge-Weber综合征的病例共9例,所有患儿均行常规CT扫描和MRI检查,其中2例同时行MRI增强扫描。结果 （1）CT表现：6例一侧脑叶受累;2例双侧额顶叶均受累;1例CT未见异常。其中5例脑叶呈中重度萎缩。8例皮层内出现脑回状钙化;3例一侧受累脑叶灰白质分界不清;2例合并一侧脉络丛扩大;1例合并有深静脉血管团出现。（2）MRI表现：9例MRI中5例一侧脑叶受累;4例双侧额顶枕叶均受累,所有患儿均有不同程度的脑萎缩,其中轻度者4例,中度者3例,重度者2例,仅有2例在萎缩的皮层下出现钙化;8例受累脑叶灰白质分界不清;5例一侧脑室内脉络丛呈囊状扩大;3例一侧颅板板障增厚;4例于侧脑室旁、室管膜下区出现粗大的静脉团。2例增强扫描后,受累侧皮层出现脑回状强化。结果 MRI与CT的综合分析。对于本病的诊断和病情的判定有一定的价值。     

腹部手术后胃瘫综合征24例诊治分析

[目的]探讨腹部手术后胃瘫综合征的发生原因、机制、诊断和治疗.[方法]回顾性分析1991年1月至2006年9月本院收治的24例腹部失手术后发生的胃瘫综合征患者的临床资料.[结果]胃切除术后发生胃瘫19例,非胃手术后发生胃瘫5例;均发生于术后5～11d.24例均行非手术治愈,治愈时间为13～31d,其中采用螺旋形鼻肠管进行肠内营养支持的患者恢复比肠外营养支持者提前.[结论]腹部手术后胃瘫综合征是由多种因素诱发的.上消化道造影及胃镜检查是诊断胃瘫的可靠方法.一般采用非手术疗法可治愈,采用螺旋形鼻肠管进行肠内营养有助于胃肠道功能的恢复.     

Case report: Laparoscopic cholecystectomy and cystic fibrosis

Summary

We report two cystic fibrosis patients with symptomatic cholelithiasis who were successfully treated by laparoscopic cholecystectomy. The procedure is safe, but it is essential that careful attention is paid to pulmonary care before and after surgery.     

75例急腹症腹腔镜诊治结果分析

目的:探讨腹腔镜技术在外科急腹症中的临床应用及其意义。方法:回顾性分析总结我院腹腔镜探查75例急腹症患者的临床资料。结果:其中74例(98.7%)经腹腔镜检查获得明确诊断,除1例患者中转开腹外,所有手术均在腹腔镜下完成,均治愈出院。结论:腹腔镜探查术对大多数外科急腹症有明确的诊治作用,值得我们在临床上不断推广、发展。     

A Rare but Distinctive Cause of Acute Abdomen: Appendiceal Diverticulitis

Background

Diverticulosis and diverticulitis of appendix vermiformis is a rare diagnosis. Clinical and laboratory examinations do not show a difference between a progressing diverticulitis and simplex appendicitis. But this entity has a higher mortality rate than common appendicitis.

Objective

This case is presented to illustrate the point that preoperative simple diagnosis of acute appendicitis according to the clinical signs and physical examination may not only be insufficient, but could be fatal in certain circumstances, like appendiceal diverticulitis, if surgical intervention is delayed.

Case Report

Here we present a female patient with a history of right lower abdominal pain and fever of 3 days duration. She was diagnosed with acute appendicitis according to the preoperative physical, laboratory, and imaging examinations. The appendiceal diverticulitis accompanying acute appendicitis was an intraoperative finding, which was proven by histopathologic examination.

Conclusion

It is not easy to document this entity preoperatively. When diagnosed either preoperatively by imaging studies or intraoperatively, the only choice is appendectomy to prevent its serious complications.     

颅内海绵状血管瘤的诊断和治疗

目的 总结颅内海绵状血管瘤（CHS）的临床及神经影像学表现和治疗效果。方法 回顾性分析1995年1月至2003年2月收治35例颅内CHS的临床资料，并复习有关文献。结果 28例CHS患者位于脑内，以头痛、癫痫及肿瘤出血为主要临床表现，均全切除肿瘤；7例患者位于脑外海绵窦区，全切除肿瘤2例，部分切除2例，肿瘤活检3例。结论 术前以CT和MRI为脑内和脑外CHS的主要诊断方法。二者在临床表现、手术难度和术后效果差异有显著性。显微外科手术切除肿瘤为颅内CHS首选治疗方法，放射外科或常规放疗适用于术前辅助治疗或术后肿瘤残留的患者。     

Dandy-Walker综合征的CT诊断

目的：探讨Ｄａｎｄｙ－Ｗａｌｋｅｒ综合征的病因、病理及ＣＴ诊断问题。材料与方法：对１０例患者头部ＣＴ资料及临床资料进行了回顾性分析。结果：典型者２例，ＣＴ表现为第四脑室极度扩张或后颅凹巨大囊肿与第四脑室呈宽口交通，小脑蚓部缺如、合并重度脑积水。变异型８例，ＣＴ表现为第四脑室下部呈袋状憩室向后突出，小脑下蚓部发育不良，一般无脑积水。结论：ＣＴ扫描对本病的诊断有很大的价值。     

SARS与普通肺炎的X线鉴别诊断

目的　分析非典型肺炎和典型肺炎的胸部X线征象 ,为鉴别诊断提供依据。方法　采用回顾性对比分析非典型肺炎和典型肺炎的发病年龄、病灶进展速度、不同时期肺内病灶的分布和形态特征。结果　非典型肺炎好发中青年 ,发病与性别无关 (P >0 .0 5 ) ,两组早期病灶多位于下肺野 ,病灶形态以肺纹理增强、斑片状分布为主 ,两者比较无显著差异 (P>0 .0 5 ) ;非典型肺炎 48h内病灶扩展速度大于 5 0 %患者多于典型肺炎 (P <0 .0 5 ) ,非典型肺炎高峰期病灶多数累及双肺 ,病灶形态呈毛玻璃样变为主 (P <0 .0 5 ) ,典型肺炎以单侧为主 ,病灶形态以片状为主 (P <0 .0 5 ) ,非典型肺炎吸收较典型肺炎缓慢。结论　认识病灶扩展速度和高峰期病灶累及范围及形态 ,有利于区分非典型肺炎和典型肺炎。