胎粪性腹膜炎的X线诊断(附60例分析)

胎粪性腹膜炎为新生儿及婴幼儿较常见的急腹症之一。本文收集我院1962～1984年间摄有腹部平片的胎粪性腹膜炎60例,其中46例手术证实,其余14例皆具有典型的胎粪钙化征,或伴有气腹征、腹膜炎征和粘连性肠梗阻征。为了探讨腹部平片对本病的诊断价值,现进行分析,并着重讨论本病的X线征象和诊断问题。     

新生儿US检查区分胎粪梗阻和回肠闭锁

胎粪梗阻和回肠闭锁在平片及灌肠检查中很难区别,因其在小肠梗阻中均表现为小结肠。胎粪造成的梗阻可用药物解除,而回肠闭锁需手术治疗。本研究的目的是为了评价US对区分这两种疾病的作用。作者复习了近10年来Arkansas儿童医院中所有胎粪梗阻和回肠闭锁患儿的腹部US情况。16例胎粪梗阻中6例及22例回肠闭锁中4例患儿均行术前US检查。     

超声检查在新生儿胎粪性腹膜炎诊断中的价值

目的:探讨超声在新生儿胎粪性腹膜炎(MP)中的诊断价值,总结MP的超声特点。方法:回顾性搜集2017年1月-2021年12月在本院经临床诊断或手术病理证实的78例胎粪性腹膜炎患儿的病例资料。结合临床资料、术中所见及病理诊断,分析和总结MP的术前超声特征以及未确诊的原因,并通过与腹部平片及其结合CT或消化道造影(放射学联合检查)的诊断结果进行比较,明确超声检查对MP的诊断价值。结果:78例中63例超声诊断为MP,诊断符合率为80.8%,腹部平片的诊断符合率为42.3%,腹部平片结合CT或消化道造影检查的诊断符合率71.8%,三种方法诊断符合率的差异有统计学意义(χ²=27.7,P<0.05)。78例的超声表现主要包括腹腔钙化灶53例,肠梗阻38例,肠粘连31例,同时伴肠粘连及肠梗阻28例,腹腔假性囊肿30例,腹腔积液21例,腹腔游离积气10例。超声未确诊的15例中3例因气体干扰严重仅诊断为腹腔胀气,2例仅诊断为腹腔积液,6例诊断为单纯肠梗阻,2例将假性囊肿诊断为单纯腹腔囊肿,2例将假性囊肿误诊为畸胎瘤。结论:胎粪性腹膜炎的超声表现具有一定的特征性,超声诊断准确...     

高密度粪石引起不完全性肠梗阻6例的CT诊断

目的：探讨全腹部CT平扫在诊断高密度粪石引起不完全性肠梗阻的临床应用价值。方法：6例病例均行全腹部CT平扫检查，保守治疗2～4d后行全腹部CT平扫复查。结果：高密度粪石引起的不完全性肠梗阻症状多样，Cr特征性表现为高密度蜂窝样粪石充满大段结肠内，结肠扩张积气，口服肠道润滑剂和灌肠治疗有效。结论：全腹部CT平扫是诊断本病的主要方法，病史、病因和CT特征性表现是诊断本病的主要依据。     

胎粪性腹膜炎的临床与影像诊断(附12例报告及文献复习)

目的 增强对胎粪性腹膜炎(MP)的影像认识,提高诊断、鉴别诊断能力.方法 回顾性分析12例MP的临床、X线及超声的影像学表现,其中9例经手术证实,3例为临床综合诊断.结果 根据X线表现,12例中3例表现为腹膜炎型,7例表现为肠梗阻型,2例表现为单纯钙化型,12例中7例出现典型的腹部钙化.12例中3例行超声检查显示腹腔内钙化强回声光团伴后方声影.结论 胎粪性腹膜炎(MP)具有较典型的临床及影像学特征.     

先天性胃肌缺损合并十二指肠闭锁一例报告

男性新生儿，年龄6天，出生后即发生禁食后反复呕吐，进行性腹胀，于1971年10月5日住院，出生后即排出胎粪，此后就不解大便，物理检查发现腹部高度膨胀，压痛，无肿块可触及，腹肌有抵抗，临床臆断为：（1）肠梗阻；（2）胎粪性腹膜炎。     

先天性细小结肠症一例报告

先天性细小结肠症是指结肠肠腔广泛发育细小,而肠壁发育正常。多认为由于结肠近端肠道的阻塞,胎粪不能通过结肠而引起。临床主要表现为频繁性呕吐,腹部膨胀和低位小肠梗阻。肛门无胎粪排出,这是一种极少见的先天性肠道畸形。现介绍如下: 患儿,男,3天,第一胎,足月顺产,其母孕期身体健康。患儿自生后一直无胎粪排出,腹胀,呕吐频繁,呕吐物为黄绿色胆汁样液体,无发热。于生后三日来我院就诊,门诊以“先天性肠梗阻”     

粪石性肠梗阻42例内科治疗分析

目的探讨粪石性肠梗阻的病因、诊断及内科处理经验。方法回顾分析近3年我科收治的42例粪石性肠梗阻的临床资料。结果 40例通过内科治疗,即给予胃肠减压、内镜下碎石、结肠治疗机洗肠等治疗后治愈,2例内科治疗无效后行手术治疗。结论结合典型病史及B超检查、腹部平片、内镜检查,可提高粪石性肠梗阻诊治的准确率,内科治疗解除粪石性肠梗阻是可行有效的办法。     

胎粪性腹膜炎三例报告

胎粪性腹膜炎较为罕见,现将我们所见3例报告于后: 例1 男性,2天。出生后不愿吃奶,呕吐,腹胀、便秘、发烧,于1960年10月5日急诊收入外科。经检查诊断为“胎粪性腹膜炎”,而急症手术。剖腹后,见腹腔有股粪,盲肠穿孔,约1.8×1.5厘米。诊断:盲肠穿孔合并胎粪性腹膜炎,乃行修补,腹腔引流。术后第5天见有腹壁创口裂开征兆,给以预防措施,未见效果。2天后,于创口处可见肠管,在已醚麻醉下再次手术,见原盲肠穿孔修补处已又裂开,且较前增大,约2.5×2厘米,腹腔有很多胎粪。乃将原切口行减张缝合,另作一戳口行盲肠造瘘,手术当天死亡。     

5915名空勤人员肠道蛔虫流行病学调查

笔者统计1980～1990年10年间在空军临潼疗养院健康疗养5915名空勤人员的粪便普查结果。粪常规化验检查蛔虫卵阳性,诊断为肠道蛔虫感染。 1 结果及分析 患有肠道蛔虫感染者598人,感染率为10.1％。体检中自述有间断腹部隐痛史(排除其它腹部疾病)者73人,占感染数的12.2％,其中因腹痛影响飞行的有11人。疗养中均给予驱蛔虫治疗,半月后,连续2次复查粪常规转为阴     

凯西莱注射液治疗慢性乙型肝炎60例疗效分析

目的　观察凯西莱注射液治疗慢性乙型肝炎 (简称慢乙肝 )疗效。方法　对 4 0例慢性乙肝采用凯西莱注射液 2 0 0mg加入 10 %葡萄糖注射液 2 5 0ml中静脉滴注 ,1/d ,疗程 2周。 结果　凯西莱注射液在改善临床症状方面 ,除胁痛腹胀无明显进步外 ,其余症状均有改善 ,治疗 14d后 ,ALT ,AST降至正常 ;该药对肾功、血象未见不良影响 ,不良反应可引起皮肤瘙痒。结论　凯西莱可以改善慢乙肝患者的临床症状和肝功能指标 ,早期疗效确切、无明显毒副作用。     

Occlusion of postcatheterisation femoral pseudoaneurysms with percutaneous thrombin injection under ultrasound guidance

PURPOSE: The incidence of iatrogenic femoral artery pseudoaneurysms is reported to occur in 1-7% by of all percutaneous catheterisations. These pseudoaneurysms are traditionally treated by ultrasound-guided compression or surgical repair. We report our experience in sealing postcatheterization femoral pseudoaneurysms with percutaneous thrombin injection under colour-Doppler ultrasound guidance. MATERIALS AND METHODS: Since June 2000 we have consecutively treated 31 pseudoaneurysms in 30 patients, (14 males and 16 females, age range 45 to 81 years); in one patient the pseudoaneurysm was bilateral. All patients had a clinical diagnosis of postcatheterization femoral pseudoaneurysm, later confirmed by colour-Doppler ultrasonography. We injected a bovine thrombin solution percutaneously at a concentration of 1000 U/mL using 21-22 gauge needles under colour Doppler ultrasound guidance. All patients underwent clinical and colour-Doppler US examination before, during and 24 hours after the procedure and were followed up after 1 and 3 months. RESULTS: The primary success rate was 83.8%. Complete and persistent occlusion of the pseudoaneurysm was achieved in less than 20 seconds by administering an average dose of 880 U of thrombin (0.8 mL of solution). In 5 cases (16.1%) reperfusion of the pseudoaneurysm was observed within 24 hours. These patients underwent a repeat procedure. The final result was successful in 96.7% of patients (30 of 31 cases). No thromboembolic complication was observed. Only 22.5% of patients reported a heat sensation in the treated limb, which resolved spontaneously within minutes. CONCLUSIONS: The percutaneous injection of thrombin under ultrasound colour-Doppler guidance should be regarded as the first choice treatment for postcatheterization femoral pseudoaneurysms, owing to its simplicity, safety, effectiveness and inexpensiveness.     

无水乙醇联合泡沫硬化剂治疗直肠静脉畸形效果和安全性分析

【摘要】　目的?探讨无水乙醇联合泡沫硬化剂治疗直肠静脉畸形（VM）的安全性和有效性。 方法?回顾性分析2017年10月至2018年5月收治的5例出血性直肠VM患儿,根据Puig分型选择经皮硬化治疗。术后随访观察有效性、不良反应和并发症。结果?5例患儿均为PuigⅡ、Ⅲ型,接受无水乙醇联合泡沫硬化剂治疗共10次（1～3次）。无水乙醇单次应用平均剂量（0.11±0.05）mL/kg,3%聚多卡醇单次应用平均剂量（2.35±0.94） mL。术后2例治愈,2例基本治愈,1例有效,有效率为100%。随访12～18个月,患儿未再有便秘或出血情况,无皮肤坏死或严重心肺系统并发症。结论?根据Puig分型采用无水乙醇联用泡沫硬化剂治疗直肠VM,可降低无水乙醇用量,提高治疗安全性,增加疗效。     

Sonography of scrotal masses in healed meconium peritonitis

Although sonography is the procedure of choice in evaluating testicular masses in infants, x-ray examination can confirm the diagnosis of healed meconium peritonitis by showing scattered intra-abdominal as well as intrascrotal calcifications. Failure to include an abdominal radiograph early in the evaluation of 2 infants admitted with hard scrotal masses resulted in delayed diagnosis of healed meconium peritonitis. The clinical progression of meconium peritonitis involving the scrotum starts with soft hydroceles at birth and progresses, as the meconium calcifies, to hard "tumor-like" masses at age 4-5 weeks. This paper stresses the sonographic characteristics of meconium peritonitis in the scrotum and the need for confirming radiographs of the abdomen.     

半导体激光治疗老年带状疱疹神经痛的临床护理

目的观察半导体激光治疗老年带状疱疹神经痛的疗效与护理特点。方法老年带状疱疹神经痛患者100例,分为两组：（1）治疗组患者50例,采用半导体激光照射病灶,每日一次,波长是810nm,治疗功率1300-1500 mW,时间10 min。同时联合常规治疗包括口服阿昔洛韦0.5 g,静脉滴注维生素B6200 mg,肌肉注射维生素B12 1 mg,共7 d。口服维生素E、维生素B1、维生素B2片。皮损有水疱者用紫药水每日2次,皮损结痂后或皮损丘疱疹时外用阿昔洛韦乳膏,每日2次。（2）对照组患者50例,只采用常规治疗,用法和疗程同治疗组。结果 100例患者,治疗后治疗组总有效率92%,对照组总有效率72%,治疗组有效率明显高于对照组。结论早期、合理的治疗和有效的综合护理对促进疾病的康复、防止后遗神经痛起着积极作用。     

Total abdominal radiotherapy in epithelial cancer of the ovary

The prognosis of ovarian cancers, which are frequently diagnosed at a late stage, can probably be improved by whole abdominal radiotherapy. 45 patients in Lyon and 8 patients in Montélimar (7 stage I or C, 10 stage II and 36 stage III) were treated by whole abdominal radiotherapy, generally after 6 courses of chemotherapy (46 cases). The overall 5-year survival of this group of patients was 48% (Kaplan-Meier method). When the patients treated by complete resection at 1st look surgery (19 cases) are compared with those in whom 1st look surgery was incomplete (34 cases), the actuarial survival was 83% versus 27%. This study demonstrates that whole abdominal radiotherapy is feasible without any serious long-term complications after two operations and 6 courses of chemotherapy. These encouraging results need to be confirmed by randomised prospective studies.     

丹参酮与葛根素注射液治疗冠心病心绞痛（附62例疗效评价）

目的：观察丹参酮联合葛根素治疗冠心病心绞痛的临床疗效及其与硝酸甘油疗效的对比。方法：将112例冠心病心绞痛患者随即分为两组,观察组给予丹参酮注射液50 mg,葛根素注射液0.5 g分别加入5%葡萄糖250 mL中静滴,1次/d。对照组采用硝酸甘油注射液10 mg加入5%葡萄糖250 mL中静滴,1次/d。2周为1疗程。观察患者治疗前后临床症状、心电图、心功能、血流动力学改善情况。结果：心绞痛症状缓解,观察组总有效率93.5%,对照组总有效率100%。心电图改善,观察组总有效率64.5%,对照组总有效率68.0%。两组比较均无明显差异。结论：丹参酮联合葛根素治疗冠心病心绞痛疗效肯定,副作用小,可以作为不能耐受硝酸甘油的替代药。     

The distended neonate

A prospective study, followed by a retrospective audit, was made of the radiographs and clinical features of 225 consecutive neonates with abdominal distension presenting during a period of 4 years. More than one major cause for the distension was found in a third of cases. Excluding cases of ano-rectal atresia, diagnostic difficulties were encountered in 31% of cases and, occasionally, the diagnosis was revised several times as investigations proceeded. Neuhauser's sign of 'bubbly' meconium is unreliable, being found in cases of meconium ileus, ileal atresia, Hirschsprung's disease and necrotising enterocolitis. Concomitant small-bowel atresia should be suspected in all cases of meconium ileus; intestinal malrotation should be considered in association with duodenal and intestinal atresias. In the absence of an obvious anatomical defect, it is difficult to differentiate between the various causes of functional obstruction by radiological means alone and all such infants should be referred to a specialised centre for intensive investigation and treatment. Very often, the skills of a neonatologist, paediatric surgeon and, especially, an experienced pathologist will be required in addition to those of the radiologist.     

硫普罗宁联合丹参注射液对慢性乙型肝炎肝纤维化指标的影响

目的观察硫普罗宁联合丹参注射液对慢性乙型肝炎肝纤维化指标的影响。方法 80例患者随机分为两组:治疗组和对照组,每组各40例;对照组患者采用丹参注射液20ml加入10%葡萄糖250ml内,静脉滴注,1次/d,疗程1个月。治疗组患者在对照组的基础上加用硫普罗宁200mg加入10%葡萄糖250ml内,静脉滴注,1次/d,疗程1个月。两组基础治疗相同。治疗前后分别检测肝纤维化指标:透明质酸(HA)、层黏连蛋白(LN)、Ⅲ型前胶原蛋白(PCⅢ)、Ⅳ型胶原蛋白(Ⅳ-C)。结果治疗组治疗前后血清肝纤维化指标均有明显下降(P<0.01)。对照组治疗前后HA,PC III有所下降,而Ⅳ-C,LN下降不明显。治疗组4项指标的下降值显著,优于对照组(P<0.05)。结论硫普罗宁联合丹参注射液治疗慢性乙型肝炎,能显著改善肝纤维化指标,可以有效抑制肝纤维化的发生与发展。     

早期液体复苏对腹部严重创伤后腹腔间隙综合征的影响

目的探讨早期液体复苏对腹部严重创伤后腹腔间隙综合征的影响。方法 2011年7月~2014年7月,笔者采用膀胱测压法监测70例危重患者腹腔内压,比较常规组和损害控制复苏组(damage control resuscitation,DCR)的每日液体平衡量及累积液体平衡总量。结果与DCR组比较,常规组住院第1、2天液体平衡量显著增加[(2 780±690)m L vs(1 728±275)m L,(1 415±1 000)m L vs(910±1 200)m L],两组在第3天液体平衡量无显著差异;常规组的1~3d累积液体平衡量较DCR组均显著增加[(2 780±690)m L vs(1 728±275)m L,(4 510±1 149)m L vs(3 250±724)m L,(5 246±1 490)m L vs(4 170±1 926)m L];DCR组的并发症发生率及死亡率均显著低于常规组。结论对腹部严重创伤患者,应积极实施DCR,可有效地减少复苏液体量、降低腹腔高压症/腹腔间隙综合征(IAH/ACS)发生率、缩短住院时间。