CAJ | 학술논문

目的分析消化道穿孔的临床特点,提高诊断率.方法回顾分析128例术后确诊为消化道穿孔患者的资料,总结其症状、体征特点及腹部X线、CT、超声等影像学特点,评价各项指标的临床诊断意义.结果 128例患者表现弥漫性腹膜刺激征者92例(71.9%),老年人较中青年缺乏典型体征[老年组:板状腹20.9%(9/43),全腹反跳痛32.6%(14/43),局部反跳痛37.2%(16/43),无反跳痛9.3%(4/43);中青年组:板状腹36.6%(30/82),全腹反跳痛51.2%(42/82),局部反跳痛11.0%(9/82),无反跳痛1.2%(1/82);P<0.01].78.7%(96/122)的患者在腹部X线片中发现膈下游离气体,低于CT检查的83.3%(15/18),差异有统计学意义(P<0.05).对X线或CT未检出的患者,诊断性腹腔穿刺的阳性结果为84.6%(11/13).结论消化道穿孔的临床表现多不典型,超声引导下诊断性腹腔穿刺可明显提高诊断率.
목적 분석소화도천공적림상특점,제고진단솔.방법 회고분석128례술후학진위소화도천공환자적자료,총결기증상、체정특점급복부X선、CT、초성등영상학특점,평개각항지표적림상진단의의.결과 128례환자표현미만성복막자격정자92례(71.9%),노년인교중청년결핍전형체정[노년조:판상복20.9%(9/43),전복반도통32.6%(14/43),국부반도통37.2%(16/43),무반도통9.3%(4/43);중청년조:판상복36.6%(30/82),전복반도통51.2%(42/82),국부반도통11.0%(9/82),무반도통1.2%(1/82);P<0.01].78.7%(96/122)적환자재복부X선편중발현격하유리기체,저우CT검사적83.3%(15/18),차이유통계학의의(P<0.05).대X선혹CT미검출적환자,진단성복강천자적양성결과위84.6%(11/13).결론 소화도천공적림상표현다불전형,초성인도하진단성복강천자가명현제고진단솔.
Objective To analyze the clinical features of atypical digestive tract perforation, and to increase diagnostic ratio. Methods Retrospectively analyze 128 patients diagnosed as digestive tract after operation, summarize the symptoms, signs and the appearance of X-ray, CT and ultrasound. Then evaluate clinical diagnostic value of those items. Results In 128 cases, 92 cases (71.9% ) had diffuse peritoneal irritation sign, and the older man easily without typical symptoms and signs (P <0.01). 78.7% (96 cases in 122) finding free air sub-diaphragm in X-ray, lower than that in CT( P < 0.05 ) , which was 83. 33% (15 cases in 18 ). For those failed in diagnosis by X-ray and CT, the positive ratio of diagnostic abdominal paracentesis was 84. 6% (11 cases in 13). Conclusions There was always no special clinical characteristic in digestive tract. And diagnostic abdominal paracentesis under ultrasound would increase the diagnosis significantly.