36例老年非创伤性下消化道穿孔临床分析

摘要

目的 分析老年非创伤性下消化道穿孔的临床特点, 以提高诊断率, 减少误诊率.方法 回顾性分析36例术后确诊的老年非创伤性下消化道穿孔患者的临床资料, 总结腹痛特点、影像学检查及腹腔穿刺阳性率, 评价各项指标的临床诊断意义.结果 36例患者手术均顺利完成, 围手术期死亡3例.其中30例患者主诉症状为腹痛, 临床表现各异, 6例患者主诉为腹胀、恶心等.腹痛时间:急性腹痛(72 h)3例(10.0%).34例术前行腹部X线发现膈下游离气体12例(35.3%);36例术前行腹部CT 检查发现腹腔游离气体及腹腔积液29例(80.6%);19例行腹部彩超检查提示腹腔积液16例(84.2%);诊断性腹腔穿刺阳性率为71.9%(23/32).结论 老年非创伤性下消化道穿孔, 其腹痛特点不存在特异性, 腹部CT检查和诊断性腹腔穿刺可显著提高诊断准确率.%Objective To analyze clinical characteristics of senile non-traumatic lower gastrointestinal perforation, and to improve diagnosis rate and reduce misdiagnosis rate.Methods A retrospective analysis was made on clinical data of 36 senile patients with postoperative diagnosed non-traumatic lower gastrointestinal perforation. Summary was made on characteristics of abdominal pain, imageological examination, and abdominocentesis positive rate. Clinical diagnostic significances of indexes were evaluated.Results All the 36 patients received successful operation, and there were 3 perioperative death cases. Clinical manifestations were various in 30 cases with main symptom as abdominal pain. There were 6 cases with abdominal distension and nausea as main symptoms. Time of abdominal pain: There were 14 cases (46.7%) with acute abdominal pain (72 h). Abdominal X-ray in 34 cases before operation showed 12 cases (35.3%) with subphrenic free air. Abdominal CT examination in 36 cases before operation showed 29 cases (80.6%) with free intraperitoneal air and seroperitoneum. Abdominal color Doppler ultrasound in 19 cases showed 16 cases (84.2%) with seroperitoneum. Positive rate of diagnostic abdominocentesis was 71.9% (23/32).Conclusion Senile non-traumatic lower gastrointestinal perforation contains no specificity of its characteristics of abdominal pain. Abdominal CT examination and diagnostic abdominocentesis can remarkably improve diagnostic accuracy.