协和医学杂志

2015, v.6(01) 35-37

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急腹症剖腹探查阴性的原因及防范策略
Negative Results of Laparotomy for Acute Abdomen: Causes and Preventions

张立阳;刘子文;马恩陵;于健春;邱辉忠;
ZHANG Li-yang;LIU Zi-wen;MA En-ling;YU Jian-chun;QIU Hui-zhong;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

目的分析剖腹探查阴性的急腹症原因,为避免不必要的探查提出防范策略。方法回顾性分析北京协和医医院1997年1月至2010年12月共27例剖腹探查阴性急腹症患者的病历资料,总结探查阴性的原因。结果 27例患者中,原发性腹膜炎6例,卵巢黄体破裂6例,急性盆腔炎4例,麻痹性肠梗阻3例,自身免疫性疾病3例,有机磷中毒1例,急性心肌梗死1例,病因不明3例。剖腹探查阴性的主要原因包括:术前病史询问不详细(6例,22%)、体格检查不准确(3例,11%)和缺少必要的实验室检查(6例,22%)。结论扎实的问诊和查体基本功结合针对性的实验室检查是减少急腹症剖腹探查阴性的关键。
Objective To analyze the causes of negative results of laparotomy for acute abdomen,and to propose strategies for the prevention of unnecessary laparotomy. Methods We reviewed the medical records of 27 cases with negative findings in laparotomy for acute abdomen in Peking Union Medical College Hospital from January 1997 to December 2010,classifying the causes of negative laparotomy results. Results In the 27 cases of acute abdomen,6 had primary peritonitis,6 rupture of corpus luteum,4 acute pelvic inflammation,3 paralytic intestinal obstruction,3 autoimmune disease,1 organic phosphorus poisoning,1 acute myocardial infarction,and 3 were of unknown causes. The main reasons for negative laparotomy results were: inadequate medical history taking( 6 cases,22%),inaccurate physical examinations( 3 cases,11%),and lack of necessary laboratory tests( 6 cases,22%). Conclusions Adequate medical history taking,accurate physical examination,and necessary laboratory tests constitute the key of preventing the occurrence of negative results of laparotomy for acute abdomen.

关键词(KeyWords): 急腹症;剖腹探查
acute abdomen;laparotomy

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作者(Author): 张立阳;刘子文;马恩陵;于健春;邱辉忠;
ZHANG Li-yang;LIU Zi-wen;MA En-ling;YU Jian-chun;QIU Hui-zhong;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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