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例1 女,31岁,农民。因右下腹持续性钝痛3d,加重伴恶心,眩晕2h入院。患者既往有阑尾炎病史。2年前行绝育手术。门诊以“慢性阑尾炎急性发作”收住外科。查体:精神一般,步入病房,T37.4℃,P84次/min,BP12/9.3kPa,腹平坦,右下腹麦氏点压痛,反跳痛明显,腹肌紧张。实验室检查:Hb98g/L,WBC11.4×10~9/L,N0.74,L0.26,拟急诊在硬膜外麻醉下行阑尾切除术,术中证实慢性阑尾炎急性发作伴右侧输卵管妊娠破裂,切除右侧输卵管及阑尾,腹腔内出血约800ml,术后追问病史得知本次发病前停经56d。 例2 女,26岁,农民。于4d前突感右下腹疼痛,渐加重,2h后腹痛剧烈,以右下腹为主,随后阴道断续流血,伴恶心,呕吐,到当地乡卫生院求治,拟诊“急性阑尾炎”给于
Example 1 Female, 31 years old, farmer. Persistent dull pain due to the right lower quadrant 3d, aggravated with nausea, dizziness 2h admission. The patient had a history of appendicitis in the past. 2 years ago, sterilization surgery. Outpatient surgery to “chronic appendicitis acute” admitted to surgery. Physical examination: the general spirit, into the ward, T37.4 ℃, P84 times / min, BP12 / 9.3kPa, flat belly, right lower quadrant abdominal pain, tenderness, rebound tenderness, abdominal muscle tension. Laboratory tests: Hb98g / L, WBC11.4 × 10 ~ 9 / L, N0.74, L0.26, the proposed emergency in the epidural anesthesia appendectomy surgery, intraoperative confirmation of acute exacerbation of chronic appendicitis with right tubal pregnancy Rupture, resection of the right fallopian tube and appendix, intraperitoneal bleeding about 800ml, postoperative history asked that the onset of menopause 56d. Example 2 Female, 26 years old, farmer. 4d before the sudden sense of right lower quadrant pain, gradually heavier, severe abdominal pain after 2h, mainly to the right lower abdomen, followed by intermittent vaginal bleeding, with nausea and vomiting, to the local township hospital for treatment, to be diagnosed with “acute appendicitis” to