淋病性腹膜炎临床诊断回顾(附30例报告)  

CLINICAL DIAGNOSTIC RETROSPECTION OF GONOCOCCAL PERITONITIS WITH REPORT OF 30 CASES

作　　者：徐祐光 郑平频[2] 

机构地区：[1]浙江省宁波市医疗中心李惠利医院普外科,浙江宁波315040 [2]浙江省宁波市第一医院病理科,浙江宁波315010

出　　处：《急诊医学》1996年第2期81-83,共3页

摘　　要：作者对30例淋病性腹膜炎临床诊断进行回顾分析。13例因误诊而行探腹术，其中11例误诊为急性阑尾炎、阑尾穿孔（84．6％），1例误为胆囊炎、胆石症（7．7％），1例误为卵巢黄体破裂（7．7％）。大多数病例有不洁性生活史。通常有以下特点：（1）就诊较晚；（2）无典型脐周转移右下腹疼痛史；（3）强直体位不明显；（4）腹部肌卫较轻，（5）右下腹压痛点固定不明显。本组30例从腹腔渗液或从阴道粘液均查见淋病双球菌（PCR技术）。结论是：从本组诊断经过中认为淋病性腹膜炎最易误诊为急性阑尾炎、阑尾穿孔。应根据病史，症状和实验室检查加以鉴别以避免不必要的剖腹探查术。30 cases with gonococcal peritonitis were reviewed. 13 patients were performed on laparotomy becauseof misdiagnoss, of whom 11 were misdiagnosed as acute appendicitis and appendical perforation, 1 as cholecystitis.and choledolithiasis (7. 7%), 1 as ovary luteal rupture (7. 7%). Most of the patients had a history of a disturbedsexual intercourse and were generally characterized by the following manifestations: 1) delayed diagnosis and treat-ment;2) no typical metastasized pain from the periumbilicus to the right hypogastric region;3) no apparent stiffattitude; 4) only showing slight guarding; 5) no determinate fastening point with tenderness at the right hypogas-tric region. Gonococci were identified in all patients (by PCR method), either from the peritoneal cavity effusionor from the vaginal mucus. Conclusion: It is concluded that gonococcal peritonitis is most likely to be misdiagnosedas acute appendicitis and appendiceal perforation. Clinical history, symptoms and laboratory examination resultsare essential in order to evade unnecessary laparotomy.

关 键 词：淋病双球菌 腹膜炎 剖腹探查 PCR 诊断 

分 类 号：R759.206[医药卫生—皮肤病学与性病学] R572.204[医药卫生—临床医学]