【摘要】 目的 探讨结核性腹膜炎的CT诊断价值。 方法 回顾性分析2009年10月-2010年7月22例经手术、病理或抗结核治疗确诊的结核性腹膜炎CT完整资料。主要观察:淋巴结、腹水、腹膜、系膜、网膜改变。 结果 淋巴结肿大12例，增强后呈“环状”强化改变。腹腔积液15例，少～中量12例，聚集在肠系膜根部、结肠旁沟及盆腔较多，CT值20～28HU。腹膜增厚16例，其中14例均匀光滑增厚，10例明显强化；大网膜增厚15例，其中饼状增厚2例、污垢样增厚9例、结节样4例。肠系膜增厚18例，3例肠袢聚集、粘连。伴有其他脏器结核13例。 结论 CT对诊断和鉴别诊断结核性腹膜炎具有较大的临床价值，结合临床多数结核性腹膜炎可作出正确诊断。【Abstract】 Objective To evaluate the diagnostic value of CT scan for tuberculotic peritonitis. Methods The complete CT image data of 22 patients with tuberculotic peritonitis confirmed by surgical, pathologically, or therapeutic procedures from October 2009 to July 2010 were retrospectively analyzed. The changes of lymph nodes, ascites, thickened peritoneum, mesentery and greater omentum were observed. Results In 22 patients, enlargement and rim enhancement of lymph nodes were found in 12; ascites with CT value of 20-28 HU was in 15, of whom 12 had small or middle amount of effusion which located in mesentery or abdominal cavity; thickened parietal peritoneum was in 16, including smooth peritoneum in 14 and evident enhancement in 10; thickened greater omeutum was in 15, including cake-like thickening in 2, filth-like thickening in 9 and tuber-like thickening in 4; thickened mesentery was in 18, including intestinal loop adhesion in 3.A total of 13 patients were combined with other tuberculosis. Conclusion CT scan is very important in diagnosing and differentially diagnosing tuberculous perinitis.
Objective To investigate the pathogenesis of acute lung injury in rats induced by intra-peritoneally injection of perforative peritonitis ascitic fluids（PPAF） and the role of L-arginine （L-Arg） in acute lung injury in this model. Methods Perforative peritonitis （PP） models were established in 60 rats and PPAF were collected. Forty-eight rats were randomly divided equally into NS group，PPAF group, and L-Arg group. Rats were randomly subjected to death at 7 h and 12 h. Peripheral blood WBC were counted，levels of NO and malondialdehyde （MDA） in serum were examined. Lung injury score and wet/dry ratio were evaluated， and level of myeloperoxidase （MPO） in lung tissues and lung cell apoptosis were tested. Results WBC count of peripheral blood, levels of NO and MDA in serum， level of MPO in lung tissue, lung injury score， wet/dry ratio， and lung cell apoptosis rate in PPAF group were significantly higher than that in NS group at each time point（P＜0.01）. Level of NO in serum in L-Arg group was higher than that in PPAF group （P＜0.01）， but lower level of MDA in serum， lower level of MPO in lung tissue and lung injury score，lower wet/dry ratio， and lung cell apoptosis rate were observed in L-Arg group（P＜0.05）. In PPAF group and L-Arg group， level of NO in serum， wet/dry ratio, and lung cell apoptosis rate were higher at 12 h than that at 7 h（P=0.000）. Serum NO level was in negative correlation with serum MDA level （r=-0.257，P=0.021）， MPO level in lung tissue（r=-0.444， P=0.011），and lung cell apoptosis（r=-0.351， P =0.010） in PPAF group and L-Arg group， but serum MDA level was in positive correlation with cell apoptosis（r=0.969， P＜0.001） in each group. Conclusions Acute lung injury rats model can be established by intra-peritoneally injection of PPAF. Enhanced oxidizing reaction and cell apoptosis take part in the occurrence of acute lung injury. L-Arg plays a protective role in acute lung injury.
目的 分析持续腹膜透析患者发生腹膜炎的情况及相关因素，降低腹膜透析患者腹膜炎发生率、退出率，提高患者的生存率、生活质量。 方法 回顾分析2011年1月－6月收治的41例在家中行持续非卧床性腹膜透析且发生腹膜炎患者的临床资料，观察腹膜炎的发生率及转归，腹膜炎症状出现后初始的处理，对腹膜炎的诱因进行分析。 结果 41例腹膜透析患者共发生腹膜炎43例次，痊愈35例（85.4%），转血液透析3例（7.3%），死亡3例（7.3%）。在症状出现初期，3例（7.3%）患者继续在家观察，10例（24.4%）患者立即到当地就医，15例（36.6%）患者采用电话咨询，13例（31.7%）患者到腹膜透析中心就诊；18例（43.9%）患者直接将腹膜透析引流液带到医院进行药敏试验。就感染诱因而言，16例（39.0%）患者未严格进行空气消毒，13例（31.7%）患者未严格进行环境清洁，10例（24.4%）患者操作过程存在污染行为。 结论 加强对居家行腹膜透析患者的初次培训、操作指导及监测，可避免腹膜炎的发生，提高患者生活质量。
【摘要】 目的 探讨肝炎后肝硬化自发性细菌性腹膜炎（spontaneous bacterial peritonitis，SBP）的诊疗情况及头孢哌酮舒巴坦联合左旋氧氟沙星对SBP的治疗效果。 方法 对2004年1月-2009年12月收治的54例肝炎后肝硬化SBP患者，应用头孢哌酮舒巴坦联合左旋氧氟沙星给与治疗，并观察分析治疗效果。 结果 肝炎后肝硬化SBP的临床表现以发热，腹痛为主，具有典型腹膜刺激征的不足半数。外周血白细胞升高者不多见，腹腔积液中白细胞计数、PMN计数和细菌培养是自发性细菌性腹膜炎的重要诊断指标。 结论 肝炎后肝硬化合并SBP的临床表现不典型。致病菌以G-杆菌为主。在早期诊断、综合治疗的基础上，头孢哌酮舒巴坦联合左旋氧氟沙星对自发性细菌性腹膜炎的治疗效果显著。【Abstract】 Objective To evaluate the diagnosis and treatment of post-hepatitis cirrhosis complicated with spontaneous bacterial peritonitis (SBP) cases and the efficacy of cefoperazone and sulbactam combined with levofloxacin in the treatment of cirrhotic patients with SBP. Methods From January 2004 to December 2009, the clinical data from 54 cases of SBP after cirrhosis were analyzed. The patients underwent the treatment of cefoperazone sulbactam combined with levofloxacin. The therapeutic effect was observed. Results The main clinical manifestations were fever and abdominal pain, and about half of the patients had the typical peritoneal irritation. Only a few patients had elevated peripheral white blood cells (WBC). The WBC count, abdominal effusion polymorphonuclearcyte count and bacteria cultivation were the indexes of diagnosis of SBP. Conclusion The clinical features of post-hepatitis cirrhosis complicated with SBP are not typical. The main pathogenic bacteria is G- bacilli. In the early diagnosis and treatment, cefoperazone sulbactam combined with levofloxacin is effective.
【Abstract】ObjectiveTo evaluate the main CT features, the morbidity of CT signs and the anatomic-pathologic bases of secondary pyogenic peritonitis (SPP). MethodsTwentyfour patients of the SPP were retrospectively studied. Emphasis was placed on the spiral CT manifestations of the SPP correlating with their anatomic-pathologic bases and the occurrence as well as the signs of primary lesions which resulted in the SPP. ResultsThe main CT manifestations of SPP revealed as follows: the thickened peritoneum, 16 in 24 cases (66.7%), of which 14 cases were smooth and 2 cases were irregular; the ascites, 15 in 24 cases (62.5%); the free air within peritoneal cavity, 9 in 24 cases (37.5%); the edema and thickening involved in the greater omentum, 8 in 24 cases (33.3%); the small bowel mesentery, 5 in 24 cases (20.8%); and the bowels’ wall, 5 in 24 cases (20.8%); the adhesions of bowels, 6 in 24 cases (25.0%). The CT manifestation of the promary lesions, which caused SPP, and the complications were shown as follows: the signs of primary lesion, 13 cases (54.2%); the inflammatory changes in retroperitoneal cavity 13 cases (54.2%); the involvements of chest 13 cases (54.2%); and the abscess in peritoneal and pelvic cavity 6 cases (25.0%). ConclusionThe main significant CT signs of SPP could be concluded as follows: thickened peritoneum, ascites, free air within peritoneal cavity, edematous and thickened greater omentum, the small bowel mesentery, and the bowels’ wall, as well as the adhesions of bowels. So, the CT scan can present plenty of CT signs, which are significant and very helpful for making an appropriate diagnosis of SPP.
ObjectiveTo compare the incidences of peritoneal dialysis (PD)-associated peritonitis among HIV and non-HIV patients, and to analyze the risk factors of PD-associated peritonitis. MethodsEnd-stage renal disease patients with HIV infection who newly started PD in West China Hospital of Sichuan University from 2012 to 2020 were retrospectively included, and non-HIV PD patients in the same period were included as controls at a ratio of 1 to 4. The risk factors of PD-associated peritonitis were analyzed by univariate analysis and multivariate logistic analysis. Kaplan-Meier survival analysis and COX regression analysis were used to compare the peritonitis-free survival between HIV group and non-HIV group. ResultsA total of 60 PD patients were included. The average follow-up time was 31.2±21.3 months. Peritonitis occurred in 7 HIV patients (58.33%) and 8 non-HIV patients (16.67%). Logistic regression analysis showed that HIV infection (P=0.018) and high platelet (>150×109/L) (P=0.032) were independent risk factors for PD-associated peritonitis. The incidence of PD-associated peritonitis in HIV patients significantly increased (HR=10.944, 95%CI 1.503 to 79.707). Kaplan-Meier survival analysis showed that the 5-year peritonitis-free survival of non-HIV group was significantly higher than that of HIV group (75.7% vs. 31.1%) (P=0.003). Multivariate COX survival analysis showed that the 5-year accumulative risk of peritonitis in HIV PD patients was 5.896 times (95%CI 1.508 to 23.043, P=0.01) higher than that of the non-HIV PD patients. ConclusionHIV infection is an independent risk factor for PD-associated peritonitis.
Objective To investigate the change of pathogenic distribution and drug resistance in peritoneal dialysis associated peritonitis (PDAP). Methods The clinical data of all the patients undergoing continuous ambulatory peritoneal dialysis and suffered from PDAP between January and December in 2014 was retrospectively collected, and the pathogens, drug resistance, outcomes and underlying causes were analyzed. Results A total of 64 patients had 72 cases of PDAP. Only 36 strains (50.0%) had positive culture results, among which 24 strains (66.7%) were Gram-positive bacteria strains, 7 strains (19.4%) were Gram-negative bacteria strains, and 5 strains (13.9%) were fungi. For Gram-positive bacteria strains, the resistance rates to vancomycin, linezolid and rifampicin were all 0%; the resistance rate to levofloxacin, gentamycin and cefazolin was 14.3%, 26.3% and 50.0%, respectively. For Gram-negative bacteria strains, the resistance rates to amikacin and imipenem were both 0%; the resistant rate to gentamycin, ceftazidime, levofloxacin and ampicillin was 28.6%, 28.6%, 42.9% and 100.0%, respectively. Conclusions The pathogenic spectrum and drug resistance in PDAP have been markedly changed. Selection of antibiotics should be chosen according to the characteristic of the pathogenic spectrum and drug resistance of each center. Great effort is still needed to improve the culture positive rate of the effluent dialysate and to improve the recovery rate of peritonitis.
ObjectiveTo investigate the diagnosis and treatment value of multi-disciplinary team (MDT) model in patient with gastric perforation combined with hyperthyroidism crisis.MethodWe summarized the experiences of MDT model in treating one case of gastric perforation with hyperthyroidism crisis in the Fuling Central Hospital of Chongqing City on February 2019.ResultsThis patient had a history of hyperthyroidism and didn’t receive systemic treatment, diagnosing as acute diffuse peritonitis and perforation of hollow organs. After MDT discussions and a series of treatments, including anti-infection, control of heart rate and hyperthyroidism, this patient underwent surgical treatment of gastric peptic ulcer perforation, during and after the surgery, this patient suffered from hyperthyroid crisis. The surgery was successful, with the operation time was about 110 min, and the blood loss was about 50 mL. There was no side injury occurred without blood transfusion, and the patient was cured and discharged on 20 days after operation. The patient was followed up for about 1 year, and the general condition and life returned to normal.ConclusionMDT discussion is a very helpful way in the treatment of gastric perforation combined with hyperthyroidism crisis and can give a better outcome.
Objective To study the effects of different carbon dioxide pneumoperitoneum pressure and time on abdominal cavity infection bacteria of peritonitis in rats, including bacteria growth and bacterial translocation. Methods Sixty Sprague Dawley rats were injected with Eseherichia coli into the abdominal cavity to establish models of intra-abdominal infection. To give 3 types of pneumoperitoneum pressure for the experimental group: 15 mm Hg (1 mm Hg=0.133 kPa) for high pressure group, 5 mm Hg for low pressure group, and blank control group for no-pneumoperitoneum. To give 2 types of experimental period: 1 h and 3 h. These 60 Sprague Dawley rats were randomly divided intomoperi 6 groups by random number table. They were treated by different pneumoperitoneum pressure and time. All rats were killed at the end of the carbon-dioxide pneumo-peritoneum experiment. Peritoneal lavage fluids and portal vein blood were taken for microbiological examinations and culture. The endotoxin content in portal vein blood was detected too. Results ① Bacteria content: bacteria counts of different pneumoperitoneum pressure groups were obviously different (F=9.02, P=0.020), bacteria counts of different experimental period groups were obviously different (F=8.47, P=0.003), the effect of time was different in different pneumoperitoneum pressure groups (F=8.07, P=0.020). ② Bacterial translocation: Bacterial translocation occurred in all 6 groups. Blood culture positive rates were similar between 1 h group and 3 h group at 3 types of pneumoperitoneum pressure groups (P>0.05). The positive rate of blood culture in high pneumoperitoneum group was significantly higher compared with the no-pneumoperitoneum group (P<0.05). ③ The endotoxin content: the endotoxin content of different pneumoperitoneum pressure groups were obviously different (F=14.70, P<0.01), the endotoxin content in plasma increased obviously in high pressure group compared with low pressure group (P=0.018) and no-pneumoperitoneum group (P<0.01), the endotoxin content in plasma increased obviously in low pressure group compared with no-pneumoperitoneum group (P=0.005). The endotoxin content of different experimental period groups were obviously different (F=148.90, P<0.01), the endotoxin content in plasma increased obviously in 3 h group compared with 1 h group. There were no significant difference in the effect of time with different pneumoperitoneum pressure groups (F=0.14, P=0.874). Conclusion CO2pneumoperitoneum promoted intestinal bacterial endotoxin and bacterial translocation in peritonitis of rats, which increased with the pressure and time.