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.%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.
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