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1 病例报告 例1.男,41岁。1994年5月行食管肿瘤切除,食管胃颈部吻合术。病理论断:食管鳞状细胞癌Ⅱ级,PTNM分期为T3N1MO。术后坚持口服抗癌药辅助化疗。1995年12月30日上午患者因出现恶心、呕吐(胃内容物)而就诊。查体腹肌无紧张,全腹无压痛和反跳痛,拟为急性肠胃炎,予带药回家治疗。当日深夜,患者突然感到右下腹剧痛,持续7h未缓解而再次入院。体温36.8℃,消瘦,全腹肌紧张,有压痛和反跳痛,压痛点以右下腹最为明显,肠鸣音减弱。白细胞8.3×1~9/L,中性粒细胞0.83。腹腔穿刺见浑浊脓液。诊断为急性弥漫性化脓性腹膜炎。剖腹探查见腹腔内充满浑浊脓液约800ml,有粪臭味,吸净脓液后查大网膜明显萎缩,腹腔内淋巴结转移,回盲部淋巴结融合成团,局部与阑尾管壁粘连,阑尾充血水肿明显,部分坏死呈黑色,距离根部1.5cm处见一直径0.5cm溃破孔,确诊为阑尾坏疽穿孔。行阑尾切除,应用0.02％洗必泰消毒剂进行腹腔冲洗并放置空心引流管引流。病理诊断为急性坏疽性阑尾炎。术后经抗炎对症处理,康复出院。半年后因腹腔淋巴结广泛转移,全身衰竭死亡。 例2.男,63岁。因突发性持续性右下腹剧痛,60余小时,于1997年2月12日转入我院。患者患有前列腺类癌伴腹腔、腹膜后和双侧腹股沟淋巴结广泛转移,正在外院进行全腹腔放射治疗,
1 Case Report Example 1. Male, 41 years old. May 1994 esophageal tumor resection, esophagogastric neck anastomosis. Disease Theory: Esophageal squamous cell carcinoma grade II, PTNM stage T3N1MO. Postoperative adherence to oral anticancer drug adjuvant chemotherapy. On the morning of December 30, 1995, the patient presented with nausea and vomiting (gastric contents). Check the abdominal muscles without tension, the whole abdomen without tenderness and rebound tenderness, intended for acute gastroenteritis, to take the drug home treatment. Late that night, the patient suddenly felt a severe pain in the right lower quadrant and he was admitted to hospital again after 7 hours without remission. Body temperature 36.8 °C, weight loss, full abdominal muscle tension, tenderness and rebound tenderness, tenderness to the right lower abdomen is most obvious, reduced bowel sounds. Leukocytes 8.3 × 1 ~ 9 / L, neutrophils 0.83. Peritoneal puncture see turbid pus. Acute diffuse pyogenic peritonitis was diagnosed. The exploratory laparotomy revealed that the abdominal cavity was filled with about 800 ml of turbid pus, with fecal odor. After purging the net pus, the omentum was significantly atrophied, the intra-abdominal lymph node metastasis, the ileocecal lymph nodes were merged into clusters, and local adhesion to the wall of the appendix was observed. Congestive edema was evident, some necrosis was black, and a 0.5 cm diameter crushing hole was seen at a distance of 1.5 cm from the root. It was diagnosed as a perforation of a nevus crater. The appendix was removed and a 0.02% chlorhexidine disinfectant was used for intraperitoneal flushing and a hollow drainage tube was placed for drainage. The pathological diagnosis was acute gangrenous appendicitis. After symptomatic treatment by anti-inflammatory, he was discharged. Six months later, due to widespread metastasis of celiac lymph nodes, systemic failure died. Example 2. Male, 63 years old. Due to sudden and persistent severe pain in the right lower abdomen, more than 60 hours, transferred to our hospital on February 12, 1997. Patients with prostate cancer with extensive metastases to the abdominal cavity, retroperitoneum, and bilateral inguinal lymph nodes are undergoing full abdominal radiotherapy in the external hospital.