BACKGROUND Hepatic portal venous gas(HPVG)generally indicates poor prognoses in patients with serious intestinal damage.Although surgical removal of the damaged portion is effective,some patients can recover with cons...BACKGROUND Hepatic portal venous gas(HPVG)generally indicates poor prognoses in patients with serious intestinal damage.Although surgical removal of the damaged portion is effective,some patients can recover with conservative treatments.AIM To establish an optimal treatment strategy for HPVG,we attempted to generate computed tomography(CT)-based criteria for determining surgical indication,and explored reliable prognostic factors in non-surgical cases.METHODS Thirty-four cases of HPVG(patients aged 34-99 years)were included.Necessity for surgery had been determined mainly by CT findings(i.e.free-air,embolism,lack of contrast enhancement of the intestinal wall,and intestinal pneumatosis).The clinical data,including treatment outcomes,were analyzed separately for the surgical cases and non-surgical cases.RESULTS Laparotomy was performed in eight cases(surgical cases).Seven patients(87.5%)survived but one(12.5%)died.In each case,severe intestinal damage was confirmed during surgery,and the necrotic portion,if present,was removed.Non-occlusive mesenteric ischemia was the most common cause(n=4).Twentysix cases were treated conservatively(non-surgical cases).Surgical treatments had been required for twelve but were abandoned because of the patients’poor general conditions.Surprisingly,however,three(25%)of the twelve inoperable patients survived.The remaining 14 of the 26 cases were diagnosed originally as being sufficiently cured by conservative treatments,and only one patient(7%)died.Comparative analyses of the fatal(n=10)and recovery(n=16)cases revealed that ascites,peritoneal irritation signs,and shock were significantly more frequent in the fatal cases.The mortality was 90%if two or all of these three clinical findings were detected.CONCLUSION HPVG related to intestinal necrosis requires surgery,and our CT-based criteria are probably useful to determine the surgical indication.In non-surgical cases,ascites,peritoneal irritation signs and shock were closely associated with poor prognoses,and are applicable as pred展开更多
目的:分析盆腔脓肿患者的临床特点,探讨影响盆腔脓肿保守治疗效果的因素。方法:回顾性分析因盆腔脓肿于重庆市6家医院进行住院治疗的240例患者的临床资料,其中保守治疗组73例,手术治疗组167例,比较并分析其临床特点、诊疗经过及治疗效...目的:分析盆腔脓肿患者的临床特点,探讨影响盆腔脓肿保守治疗效果的因素。方法:回顾性分析因盆腔脓肿于重庆市6家医院进行住院治疗的240例患者的临床资料,其中保守治疗组73例,手术治疗组167例,比较并分析其临床特点、诊疗经过及治疗效果。结果:保守治疗组患者脓肿直径小,多为单侧病灶(P<0.05),包块直径大于5.8 cm时预测手术干预的敏感性为81.3%;保守治疗组患者自症状加重至入院时间间隔短(P<0.05);而年龄、宫内节育器(IUD)的使用、C-反应蛋白(CRP)水平、盆腔手术史、合并子宫内膜异位症(EMT)等因素与手术治疗组差异无统计学意义(P>0.05)。手术治疗组中17.4%(4/23)的患者子宫颈分泌物和腹腔脓液培养为同种细菌,39.1%(9/23)细菌培养结果不一致。均行降钙素原(PCT)检查的重症患者(19例)较普通患者(34例)的白细胞(WBC)(16.51×10^(9)/L vs 12.00×10^(9)/L)及PCT水平(0.57 ng/L vs 0.14 ng/L)明显升高,差异有统计学意义(P<0.05)。结论:影响盆腔脓肿患者保守治疗效果的因素有脓肿直径、病灶位置与症状加重至入院时间间隔;双侧病灶者可积极选择手术治疗;盆腔脓肿患者子宫颈与盆腔致病微生物的组成可能有所不同,保守治疗效果不佳者应尽量手术取得感染病灶标本进行培养和药敏检测;PCT可监测重症患者疾病发展与转归。展开更多
文摘BACKGROUND Hepatic portal venous gas(HPVG)generally indicates poor prognoses in patients with serious intestinal damage.Although surgical removal of the damaged portion is effective,some patients can recover with conservative treatments.AIM To establish an optimal treatment strategy for HPVG,we attempted to generate computed tomography(CT)-based criteria for determining surgical indication,and explored reliable prognostic factors in non-surgical cases.METHODS Thirty-four cases of HPVG(patients aged 34-99 years)were included.Necessity for surgery had been determined mainly by CT findings(i.e.free-air,embolism,lack of contrast enhancement of the intestinal wall,and intestinal pneumatosis).The clinical data,including treatment outcomes,were analyzed separately for the surgical cases and non-surgical cases.RESULTS Laparotomy was performed in eight cases(surgical cases).Seven patients(87.5%)survived but one(12.5%)died.In each case,severe intestinal damage was confirmed during surgery,and the necrotic portion,if present,was removed.Non-occlusive mesenteric ischemia was the most common cause(n=4).Twentysix cases were treated conservatively(non-surgical cases).Surgical treatments had been required for twelve but were abandoned because of the patients’poor general conditions.Surprisingly,however,three(25%)of the twelve inoperable patients survived.The remaining 14 of the 26 cases were diagnosed originally as being sufficiently cured by conservative treatments,and only one patient(7%)died.Comparative analyses of the fatal(n=10)and recovery(n=16)cases revealed that ascites,peritoneal irritation signs,and shock were significantly more frequent in the fatal cases.The mortality was 90%if two or all of these three clinical findings were detected.CONCLUSION HPVG related to intestinal necrosis requires surgery,and our CT-based criteria are probably useful to determine the surgical indication.In non-surgical cases,ascites,peritoneal irritation signs and shock were closely associated with poor prognoses,and are applicable as pred
文摘目的:分析盆腔脓肿患者的临床特点,探讨影响盆腔脓肿保守治疗效果的因素。方法:回顾性分析因盆腔脓肿于重庆市6家医院进行住院治疗的240例患者的临床资料,其中保守治疗组73例,手术治疗组167例,比较并分析其临床特点、诊疗经过及治疗效果。结果:保守治疗组患者脓肿直径小,多为单侧病灶(P<0.05),包块直径大于5.8 cm时预测手术干预的敏感性为81.3%;保守治疗组患者自症状加重至入院时间间隔短(P<0.05);而年龄、宫内节育器(IUD)的使用、C-反应蛋白(CRP)水平、盆腔手术史、合并子宫内膜异位症(EMT)等因素与手术治疗组差异无统计学意义(P>0.05)。手术治疗组中17.4%(4/23)的患者子宫颈分泌物和腹腔脓液培养为同种细菌,39.1%(9/23)细菌培养结果不一致。均行降钙素原(PCT)检查的重症患者(19例)较普通患者(34例)的白细胞(WBC)(16.51×10^(9)/L vs 12.00×10^(9)/L)及PCT水平(0.57 ng/L vs 0.14 ng/L)明显升高,差异有统计学意义(P<0.05)。结论:影响盆腔脓肿患者保守治疗效果的因素有脓肿直径、病灶位置与症状加重至入院时间间隔;双侧病灶者可积极选择手术治疗;盆腔脓肿患者子宫颈与盆腔致病微生物的组成可能有所不同,保守治疗效果不佳者应尽量手术取得感染病灶标本进行培养和药敏检测;PCT可监测重症患者疾病发展与转归。
