基层医院老年外科急腹症的诊治体会

老年外科急腹症临床表现有特殊性 ,常导致诊断困难或误诊误治。1　临床资料本院 2 0 0 1～ 2 0 0 2年 7月共收治老年急腹症病人 39例 ,男2 1例 ,女 18例 ,年龄 6 0～ 92岁 ,平均 6 9岁。其中急性阑尾炎 16例 ,胃十二指肠溃疡 (癌肿 )穿孔、梗阻 7例 ,胆囊炎 8例 ,胆管炎 3例 ,脾破裂 1例 ,肠系膜血栓肠坏死 1例 ,特异性小肠炎穿孔 3例 ,并发感染中毒性休克 7例。并存病 (每例有多种并存病 ) :慢性支气管炎 13例 ,糖尿病10例 ,高血压 9例 ,冠心病 2 2例。术后发生并发症 2 1例 :切口感染 3例 ,腹腔脓肿 1例 ,肺内感染 7例 ,尿路感染 8例 ,急…     

应用腹腔镜治疗外科急腹症150例报告

本文报告应用腹腔镜技术治疗外科急腹症１５０例，其中９２例急性胆囊炎完成腹腔镜下胆囊切除术８１例，５０例急性阑尾炎完成腹腔镜下阑尾切除术４４例，胃、十二指肠球部溃疡穿孔腹腔镜修补５例，脾破裂、粘连性肠梗阻、原发性腹膜炎各１例腹腔镜手术均获成功。完成腹腔镜手术者术后恢复快，并发症少，取得了较满意的效果，本文介绍了腹腔镜治疗多种急腹症的操作要点及技巧，并提出急腹症行急诊腹腔镜探查的指征。     

老年外科急腹症诊治

老年外科急腹症是一组严重疾病,往往需要进行外科急症手术或在病程中接受外科手术处理。若得不到及时有效的治疗,患者相当危险,且有可能威胁生命。本文对老年外科急腹症的临床特点、诊断、处理原则、手术、微创治疗进行系统阐述。     

老年大肠癌急性梗阻的外科治疗

目的 探讨老年大肠癌急性梗阻外科治疗的有关问题。方法 回顾性分析1994年1月至2000年3月41例65岁以上老年大肠癌急性梗阻病人的外科处理。结果 老年大肠癌急性梗阻以右半结肠居多,占63．41％,一期切除31例,占75．61％,其中根治性切除26例,结肠造口4例,短路6例,围手术期死亡4例。结论 对老年大肠癌急性梗阻应加强术前诊断和认识,充分的术前准备,适当的手术时机和手术方式的选择,加强围手术期的营养支持,是手术成功的有效措施。     

老年急性戊型肝炎患者合并急腹症17例治疗体会

老年人患急性戊型肝炎,临床症状重,预后凶险[1] ,一旦合并急腹症,治疗难度大,疗效差。1999年6月至2 0 0 2年12月我科收治17例老年急性戊型肝炎合并急腹症患者,治疗体会如下。1　资料和方法17例均为我院感染科确诊为急性戊型肝炎,住院期间发生急腹症转入我科的老年患者。男15例,     

老年急腹症手术治疗126例麻醉体会

老年急腹症手术治疗１２６例麻醉体会沈桂莲扬州市第四人民医院（２２５００２）我院自１９９０年５月以来共为１２６例老年急腹症患者做了各类急诊手术，术中无１例死亡，现将麻醉处理报道如下。１临床资料１．１一般资料本组１２６例中，男８９例，女３７例；年龄６０～...     

老年左半结肠癌合并肠梗阻的外科治疗

结肠癌合并肠梗阻是临床上常见的外科急腹症之一,亦是老年急腹症的常见原因,其中左半结肠癌合并肠梗阻的发生率及病死率较高,尤其老年患者,起病隐匿,对疼痛等不敏感,多伴发其他多种慢性疾病,临床诊治较为困难。     

外科急腹症的诊断

“外科急腹症”是常见病多发病，它们有共同的特点是发病急，变化快，病情有时很复杂。因此必须在短时间内做出恰当的诊断和合理的治疗，常可有效的挽救病人生命，减少病残和痛苦，否则就会增加病人痛苦、延长病程，出现病残，甚至死亡。而引起急腹症的原因很多。除了腹内脏器病变外，还有妇科病、内科病均可引起外科急腹症的表现。因此急急腹症病人的病史和体检，对作出正确诊断比择期入院病人就更重要。甚至是唯一的诊断线索。急腹症的诊断：对急腹症病人的病史的询问和症状分析，是诊断急腹症的重要步骤。     

老年颅内动脉瘤的外科治疗体会

随着显微外科手术的广泛应用,动脉瘤颈夹闭仍然是治疗颅内动脉瘤的有效方法.本文回顾性分析我科2007年7月至2009年7月应用显微手术治疗老年颅内动脉瘤26例治疗体会.     

腹腔镜技术在急腹症1035例诊治中的应用

目的评价腹腔镜技术在基层医院急腹症的诊断和治疗中的可行性和有效性。方法回顾分析2005-03～2012-11的1035例腹腔镜急腹症手术的临床资料。结果 1034例急腹症患者均于腹腔镜下作出正确诊断,诊断准确率为99.9%。其中镜下完成手术1028例,中转开腹手术6例,阴性探查1例。结论腹腔镜技术应用于急腹症诊治,值得在临床推广。     

系统性红斑狼疮伴发急腹症20例分析及文献复习

目的 提高对系统性红斑狼疮（SLE）伴发急腹症（AA）临床多样性的认识。总结治疗此类病例的经验。方法 对20例SLE伴发AA的病例做回顾性分析。并复习35年相关文献。结果 AA多数是SLE病情活动的表现（70%），也可能由独立于SLE的其他疾病引直民（30%），病变广泛多变，容易误诊，早期确定采用保守或手术治疗是提高生存率的关键。结论 SLE伴发AA预示病情危重，应尽早明确AA的原因，恰当选择治疗措施。     

Laparoscopy in the acute abdomen

Laparoscopy has become a routine procedure in the management of acute abdominal disease and can be considered both an excellent therapeutic and additional diagnostic tool in selected cases. However, a high level of expertise in laparoscopic and emergency surgery is required. Hemodynamic instability, huge abdominal distension, fecal peritonitis and perforated cancer are relative contraindications for the laparoscopic approach. In recent years, abdominal emergencies have increasingly been managed successfully by laparoscopy. In acute appendicitis, acute cholecystitis and perforated peptic ulcer, randomized controlled trials have proven that the laparoscopic approach is as safe and as effective as open surgery, with fewer complications and a quicker postoperative recovery. Other indications such as blunt and penetrating trauma to the abdomen, small bowel occlusion and perforated diverticular disease are under debate, indicating that more randomized controlled trials comparing laparoscopic and open surgery are still necessary.     

Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines

Cholecystectomy has been widely performed in the treatment of acute cholecystitis, and laparoscopic cholecystectomy has been increasingly adopted as the method of surgery over the past 15 years. Despite the success of laparoscopic cholecystectomy as an elective treatment for symptomatic gallstones, acute cholecystitis was initially considered a contraindication for laparoscopic cholecystectomy. The reasons for it being considered a contraindication were the technical difficulty of performing it in acute cholecystitis and the development of complications, including bile duct injury, bowel injury, and hepatic injury. However, laparoscopic cholecystectomy is now accepted as being safe for acute cholecystitis, when surgeons who are expert at the laparoscopic technique perform it. Laparoscopic cholecystectomy has been found to be superior to open cholecystectomy as a treatment for acute cholecystitis because of a lower incidence of complications, shorter length of postoperative hospital stay, quicker recuperation, and earlier return to work. However, laparoscopic cholecystectomy for acute cholecystitis has not become routine, because the timing and approach to the surgical management in patients with acute cholecystitis is still a matter of controversy. These Guidelines describe the timing of and the optimal surgical treatment of acute cholecystitis in a question-and-answer format.     

80岁以上患者外科急腹症的诊治特点

目的分析≥80岁外科急腹症住院患者的诊治特点。方法将2002年1月1日至2009年12月31日外科急腹症入院治疗的5426例患者按年龄分为≥80岁组和〈80岁组。观察≥80岁急腹症患者人数、所占比例、病种分布、伴发疾病等特点;统计分析手术比率、治疗效果、病死率、住院时间和住院花费。结果我院8年来纳入患者5426例,≥80岁患者420例,数量和所占百分比总体呈逐年增加趋势。患者从症状发作到就诊时间差2h至21d不等。常伴发多种疾病,以呼吸和心血管系统疾病居多。≥80岁组与〈80岁组比较,急诊手术率下降（48．09％比64．19％,P〈0．01）,病死率增加（3．33％比1．38％,P〈0．01）,住院时间延长[（16．76±11．49）d比（14．50±16．08）d,P〈0．01）],人均住院花费增加[（23733．11±30571．75）元比（18530．83±29637．46）元,P〈0．01）]。结论根据t〉80岁患者的发病特点制定个体化诊治方案;在制定卫生经济学政策和医疗保险制度时,注意考虑年龄对住院患者病死率、住院时间和治疗费用的影响。     

Acute abdomen due to endometriosis as a diagnostic and therapeutic challenge in the treatment of acute myelocytic leukemia

 Acute abdomial pain is a frequent diagnostic and therapeutic challenge in hematologic patients. We report on the very rare case of organ endometriosis with acute abdominal symptoms in a 43-year-old female patient with AML-M5, starting 4 days after induction chemotherapy with idarubicin, ara-C, and etoposide. The patient presented with an acute abdomen with clinical findings of acute cholecystitis, subileus, and local pain in the right upper abdomen accompanied by severe diarrhea. Probably due to impaired intestinal resorption, menstrual bleeding occurred despite regular administration of lynestrenol. Ultrasound examination of the abdomen disclosed a tumor with poor echoes in the pouch of Douglas, a subcapsular splenic hemorrhage, and a thickened gallbladder wall with surrounding edema. A cystic adnex tumor was confirmed by endovaginal ultrasound. Based on history and the findings on ultrasound, an endometriosis was diagnosed, and the LHRH agonist (nafarelin) was administered nasally in combination with lynestrenol. Following this medication the abdominal pain ceased, supporting the diagnosis of endometriosis. Nasal administration of an LHRH agonist in the following cycles of chemotherapy was effective in preventing further abdominal discomfort and vaginal bleeding. LHRH agonists should be given to patients with known endometriosis before starting myeloablative chemotherapy to prevent painful hemorrhage from endometriosis. Received: 20 June 1996 / Accepted: 11 October 1996     

急性心肌梗死合并心源性休克的手术治疗体会(附7例报告)

目的:总结我院急性心肌梗死(AMI)合并心源性休克(CS)患者的急诊手术治疗经验。方法:回顾性分析2006年1月至2009年1月在我院进行的7例冠心病合并心源性休克患者的急诊手术,均采用on-pump CABG手术,心肌保护方式采用顺灌结合经冠状静脉逆灌心肌保护方式。结果:围手术期死亡2例,死亡病例均出现顽固性低心排出量综合征(低心排),其中1例同时合并肾功能衰竭及消化道大出血;存活5例,均治愈出院。结论:急诊冠状动脉搭桥手术可以有效提高此类患者的生存率。     

Spontaneous rectus sheath hematoma presenting as acute surgical abdomen: an important differential in elderly coagulopathic patients

Rectus sheath hematoma (RSH) presenting as acute surgical abdomen is a rare clinical entity. Failing to establish an early diagnosis will probably result in increased morbidity or unnecessary surgical intervention. We describe herein a case of an 85-year-old woman receiving anticoagulants who presented with typical clinical manifestations of acute surgical abdomen and a slightly palpable abdominal mass. Ultrasonography was inconclusive whereas computed tomography scans demonstrated a large right rectus sheath hematoma associated with hemoperitoneum. The patient was treated conservatively with success. It is therefore concluded that RSH must be considered in any elderly patient on anticoagulant therapy who presents with manifestations of acute surgical abdomen.