【摘要】 目的 提高對系統性紅斑狼瘡(SLE)并發急腹癥(AA)臨床復雜性的認識,總結診治經驗。方法 對2008年以來收治20例系統性紅斑狼瘡并發急腹癥的患者進行回顧性分析,并復習近9年相關文獻。結果 系統性紅斑狼瘡住院患者中并發急腹癥發生率2.56％；急腹癥多數(80%)與系統性紅斑狼瘡病情活動相關,也可能由獨立于系統性紅斑狼瘡的其他疾病引起(20%),病情復雜,容易誤診。腹部CT尤其是增強CT檢查對確定系統性紅斑狼瘡相關急腹癥病因有重要作用。結論 系統性紅斑狼瘡活動是系統性紅斑狼瘡并發急腹癥最主要的原因,SLEDAI評分在系統性紅斑狼瘡并發急腹癥鑒別診斷中有一定作用。及時診斷、正確治療后,系統性紅斑狼瘡活動相關急腹癥患者的預后較好。
ObjectiveTo explore the feasibility and safety of the artificial pneumoperitoneum and gastrointestinal contrast CT imaging, and imaging diagnostic value on abdominal wall adhesion to intestine after operation. MethodsThirtynine patients with adhesive intestinal obstruction after operation relieved by conservative therapy were included from January 2008 to November 2009. After the artificial pneumoperitoneum established by injection of gas into abdominal cavity and gastrointestinal comparison by oral administration low concentration of meglucamine diatrizoate, CT scan imaging was performed and the radiographic results were compared with surgical findings. ResultsFour patients refused surgery and discharged, so enterolysis was performed in the remaining patients. The surgical findings were consistent with radiographic results. It was showed by laparoscopic operation that intestinal obstruction caused by the fibrous adhesions and the intestine did not adhere to the abdominal wall in eight patients with fibrous adhesion diagnosed by CT. Of eighteen patients with the abdominal wall septally adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed “M”type adhesions and omentum adhesions in sixteen patients underwent open operation, and clear fat space was showed in eight patients and close adhesion was found in another eight patients between the intestine and abdominal wall. Of thirteen patients with the abdominal wall tentiformly adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed continuous and tentiform adhesions and omentum adhesions to the intestine in eleven patients. After the followup of 6-18 months (mean 9 months), incomplete intestinal obstruction occurred in one patient and was relieved by conservative treatment. One patient with discontinuous discomfort in abdomen after operation did not receive any treatment. The other patients were cured. ConclusionThe artificial pneumoperitoneum and gastrointestinal contrast CT imaging can accurately show the location, area, and structure composition of the postoperative abdominal wall adhesion to intestine, which is safety, simple, and bly repeatable, and a better imaging method for the diagnosing of abdominal wall adhesion to intestine after operation.