B型超声在小儿急腹症的应用

Ｂ型超声检查能为小儿急腹症诊断提供图象依据，有助于选择手术方式及现察疗效，已广泛用于儿科临床，本文对该院十年中小儿急腹症１０５９例进行回顾分析，并对各主要病种的超声图像特征分别作了总结，超声诊断与临床符合率为９６．１％。     

小儿急腹症86例的诊治体会

目的 探讨鉴别小儿内科、外科急腹症的临床表现在诊治方面的意义。方法 回顾分析1997年～2000年86例小儿急腹症的临床表现、诊断及治疗结果。结果 本组基本上为小儿外科急腹症，1例肠套叠因延误治疗，术后死亡。1例术中证实为肠系膜淋巴结炎，实施了不必要的手术，其他均治愈。结论 全面、反复、动态观察是正确鉴小儿内、外科急腹症并做出正确诊治的关键。     

以急腹症就诊的小儿卵巢肿瘤14例临床分析

小儿患卵巢肿瘤比较少见。约占15岁以下小儿肿瘤的1％，大多发生于学龄儿童，偶见于婴幼儿。我院于1996年1月—2002年12月共收治小儿卵巢肿瘤38例。其中以急腹症就诊14例。现就其发病特点、诊断、治疗等问题进行回顾性分析。     

腹型过敏性紫癜与小儿急腹症（附22例报告）

总结１９８８年～１９９６年小儿外科收治的２２例腹型过敏性紫癜，其中１７例误诊为外科急腹症，５例合并外科急腹症，分析腹型过敏性紫癜误诊原因，与外科急腹症相鉴别的特征和合并外科急腹症时的诊治要点，认为小儿腹型过敏性紫癜与外科急腹症易混淆，鉴别诊断和明确是否合并外科急腹症非常重要。     

小儿血液系统恶性疾病合并外科急腹症的诊治分析

目的探讨小儿血液系统恶性疾病合并外科急腹症的诊断与治疗,以提高对小儿恶性血液病并发急腹症的认识,改善该类患者的预后。方法对13例恶性血液病并发急腹症患者进行回顾性分析。13例中,急性淋巴细胞白血病6例,MDS转化的急性髓细胞白血病1例,慢性粒细胞白血病1例,红白血病1例,再生障碍性贫血2例,淋巴瘤2例。7例行手术治疗,6例予保守治疗。结果7例手术患儿中,4例急腹症获治愈,待内科疾病缓解后出院;1例急腹症治愈,后死于内科疾病;2例术后早期自动出院,其中1例死亡。6例保守治疗患儿中1例死亡,5例临床症状缓解。结论各种恶性血液病在疾病的任何阶段均可并发多种急腹症,手术治疗是挽救患儿生命的重要手段之一。应根据原发病所处的阶段以及急腹症的类型和严重程度,给予及时诊断和恰当治疗,以利于改善该类患者的预后。     

小儿急腹症的腹痛特点

摘要：小儿急腹症腹痛具有发生急骤、进展迅速和疼痛定位相对固定的临床特点。小儿各系统器官处于不断发育阶段以及受语言表达能力限制,使急腹症的诊断较为困难。应强调临床全面检查,特别注意腹部触诊和肛门指诊的特殊性。正确认识小儿急腹症的腹痛特点才能提高诊断水平。     

小儿女性内外生殖器畸形误诊的原因及其治疗

１９９０年以来收治女性内外生殖器畸形１０例，其中处女膜闭锁６例、阴道闭锁３例、子宫阴道重复畸形伴右肾发育不良１例。年龄：２个月１例、１岁１例、１２岁２例、１３岁６例。除２例处女膜闭锁入院前作出正确诊断外，其余８例急诊入院时多诊为其他外科疾病。１０例均行手术治疗，效果良好。     

Imaging in acute abdomen

Objective The present study aims at establishing the exact role and limitation of ultrasound in pediatric acute abdomen.Methods Fifty children less than 14 years of age presenting with acute abdomen were evaluated by US and other imaging modalities. The mean age of presentation was 312 years. Maximum number of cases were seen in less than two years of age. There were 17 cases of intussusception with US sensitivity and specificity of 88.2% and 100% respectively and positive and negative predictive values of 100% and 94.5% respectively. There were 13 cases of appendicitis. US was diagnostic in 11 with sensitivity and specificity of 91.6% and 97%; the positive and negative predictive values were 91.6% and 97% respectively.Results : There were two cases each of congenital bands, adhesive intestinal obstruction, malrotation of bowel with volvulus, incarcerated inguinal hernia, hypertrophic pyloric stenosis, duplication cyst and pseudopancreatic cyst, one case each of trichobezoar, Meckel’s diverticulum, ureteric calculus and worms as a cause of intestinal obstruction. The sensitivity of US for diagnosing specific cause of acute abdomen was found to be 77.5%. The main limitation of US was in the diagnosis of acute intestinal obstruction such as congenital bands and adhesions.Conclusion. US should now be considered as imaging modality of choice in pediatric acute abdomen. However, at times, plain radiography, conventional contrast studies and CT may be vital to reach the true diagnosis     

Post varicella hepatic actinomycosis in a 5-year-old girl mimicking acute abdomen

Actinomycosis is an indolent, slowly progressive infection caused by gram-positive, anaerobic or microaerophilic bacteria. Hepatic involvement is rare and generally secondary to abdominal or thoracic actinomycosis. Hepatic actinomycosis in children may mimic a wide variety of diseases and thus make the diagnosis much more challenging. Here, we report a 5-year-old girl with apparently primary hepatic actinomycosis mimicking acute abdomen 2 weeks after varicella. The diagnosis was made by ultrasonic guided fine needle aspiration biopsy of a hypoechoic lesion of 3.5 cm diameter in the liver showing sulfur granules surrounded by neutrophils. Hepatic actinomycosis should be taken into account when evaluating acute abdomen symptoms in children.     

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目的探讨小儿异位胃黏膜症合并急腹症的临床特点。方法回顾分析了2000-12—2005-12中国医科大学第二临床学院收治的55例经病理证实存在异位胃黏膜的急腹症患儿,对其临床资料进行分类汇总和分析。结果男44例,女11例;年龄3个月至13岁,平均4·5岁。临床诊断下消化道出血31例,急性肠套叠13例,急性肠梗阻5例,急性腹膜炎6例;手术切除肠管标本经病理检查证实均有异位胃黏膜。其中Meckel憩室40例,肠重复畸形11例,肠壁正常4例。结论异位胃黏膜可能是小儿急腹症的病因之一;急腹症患儿ECT检查阴性也应开腹探查,以免遗漏异位胃黏膜。     

川崎病并发急腹症的再认识

川崎病(KD)是一种以全身血管性病变为主的急性发热性出疹性疾病,多发于婴幼儿,主要累及全身中小动脉,可并发冠状动脉病变、心肌炎、间质性肺炎、无菌性脑膜炎等。近年来KD并发急腹症,如胆囊炎、胰腺炎、肠梗阻等也受到重视,早期识别KD并发急腹症的表现,及时给予相应治疗,有助于改善KD致冠状动脉病变及并发急腹症的预后。     

Cryptococcal mesenteric lymphadenitis: an unusual cause of acute abdomen

Cryptococcal infection of intraabdominal organs or tissues is extremely rare. Herein we report a child with mesenteric cryptococcal lymphadenitis who presented with an acute abdomen misdiagnosed as acute appendicitis. Definitive diagnosis was established with 2nd look and lymph node biopsy. Clinicians should remember that cryptococcal infection of mesenteric lymph nodes may rarely mimic an acute abdomen and cause delay in diagnosis.     

高迁移率族蛋白B1对儿童急性阑尾炎的诊断价值

目的 探讨高迁移率族蛋白 B1（HMGB1）对儿童急性阑尾炎的诊断价值。方法 2013 年 1~7月门诊及住院疑似急性阑尾炎的急腹症患儿及同期来院体检的 25 名健康儿童纳入该研究。入院后采用 ELISA检测血清 HMGB1 水平。根据手术所见及病理学检查结果等将患儿分为急性阑尾炎组（n=28）和非急性阑尾炎急腹症组（n=35）。结果 急性阑尾炎组和非急性阑尾炎急腹症组外周血 WBC、血清 HMGB1 均显著高于健康儿童组（PP结论 HMGB1 对儿童急性阑尾炎具有一定的诊断价值。     

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??Sudden and violent abdominal pain with comparatively fixed location should be clinical features in children with acute abdominal diseases. The constant development of system and organs in childhood makes it difficult for pediatricians to make correct diagnosis of pediatric acute abdomen. Complete inspection and particularly abdominal palpation and digital examination should be emphasized. Correct understanding of abdominal pain in children with acute abdominal diseases is of critical importance.     

Effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen: a prospective randomized controlled study北大核心CSCD

目的 探讨生长抑素对急腹症患儿术后胃肠功能及应激水平的影响。 方法 选取2019年8月至2021年6月徐州市儿童医院收治的行手术治疗的102例急腹症患儿为研究对象。将患儿随机分为观察组和对照组,每组各51例。对照组患儿术后给予止血、抗感染等常规治疗,观察组在常规治疗的基础上加用生长抑素。术前、术后第1天及术后第5天采集两组患儿外周血,比较两组患儿血清血管内皮素-1（endothelin-1,ET-1）、促肾上腺皮质激素（adrenocorticotropic hormone,ACTH）、皮质醇（cortisol,Cor）及胃泌素、胃动素水平,以及两组患儿术后恢复情况及并发症发生率。 结果 术前两组患儿血清ET-1、ACTH、Cor、胃动素及胃泌素水平差异无统计学意义（P>0.05）。术后第1天、第5天,观察组患儿血清ET-1、ACTH、Cor水平均显著低于对照组（P<0.05）;术后第5天,观察组患儿胃动素与胃泌素水平均高于对照组（P<0.05）。术后观察组患儿首次肛门排气时间、肠鸣音恢复时间、首次排便时间、住院时间均较对照组缩短（P<0.05）。观察组并发症发生率（6%）显著低于对照组（24%,P<0.05）。 结论 生长抑素可显著降低急腹症患儿术后应激反应,改善胃肠功能,降低并发症发生率,有益于疾病预后。     

An unusual cause of acute abdomen: torsion of colonic duplication over a duplicated appendix

A 2-year old boy with torsion of colonic duplication, which had a proximal communication with the cecum via an incomplete duplicated appendix, is presented. The clinical picture and complications of this rare association are discussed.     

Rapidly enlarging solitary nonparasitic cyst of the liver in a child presenting as acute abdomen

Symptomatic solitary nonparasitic cysts of the liver (SNCL) are rarely encountered in children, especially rapidly enlarging cysts presenting as acute abdomen. Therefore, it is difficult to establish the pre-operative diagnosis and to determine the treatment protocol of SNCL. While imaging techniques such as ultrasonography and computed tomography are modalities for diagnosis of SNCL, making a pre-operative diagnosis in the case of very large cysts remains difficult. We present a child with SNCL who initially presented with a rapidly enlarging cyst presenting as acute abdomen, and also provide a review of the literature. Moreover, we evaluate the surgical procedures and conclude that total excision of the cysts when possible is a suitable treatment procedure in children. This study was not supported by any grant.