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1病历摘要 患者男性,23岁。发烧左腰背部疼痛20天于1995年3月4日收住院诊治。20天前始发烧,体温波动于38～39℃,伴有左腰背部疼痛,便前痛剧,便后痛减,大便稀薄,无粘液血便,乡医静点10天青霉素无好转来院诊治。查体:T38.6℃,发育正常,营养欠佳,体质消瘦,慢性病容,皮肤巩膜无黄染,表浅淋巴结无肿大心肺(-),腹部平坦,无胃肠型及蠕动波,左中腹部压痛,未触及包块,左后背部饱满,局限性隆起,明显压痛,无明显波动。 化验:Hb110g/L,RBC3.5×1012,WBC21.2×109(N0.96,L0.04),结核菌素实验阴性 B超:左腰背部有10cm×6cm×3cm液性暗区,内有不规则光点回声。腰椎正侧位正常。 入院诊为左腰背部脓肿,第2天穿刺抽得10ml稀薄微臭之脓汁,在硬膜外麻醉下行脓肿切排术。术中见背部肌间隙有12cm×8cm×6cm脓腔,吸引器吸净脓汁,脓腔底面有0.7cm瘘口,挤压有粪汁外溢,取组织一块送检,干纱布填塞。术后自伤口排便。病检示降结肠低分化粘液腺癌,广泛肌层转移。经充分肠道准备后,于住院第7天在硬膜外麻醉下行剖腹探查术。取左侧经腹直肌切口,打开腹腔后,降结肠中段有4cm肠腔外形狭窄,于后腹壁粘连,切开侧腹膜,分出输尿管,游离降结肠,强行分离病变处之粘连,脓腔和腹腔相通。行估息性左半结肠结除,横结肠、乙状结肠端端吻合,关?
1 medical record summary The patient male is 23 years old. Fever left lower back pain for 20 days on March 4, 1995 admission treatment. 20 days before the beginning of fever, body temperature fluctuations in the 38 ~ 39 °C, accompanied by left lower back pain, then pain before the show, will be reduced after the pain, thin stool, no mucus bloody, the township doctors for 10 days penicillin did not improve to the hospital for treatment. Physical examination: T38.6°C, normal development, poor nutrition, weight loss, chronic disease, no yellow staining of skin sclera, no swelling of superficial lymph nodes (-), flat abdomen, no gastrointestinal type and peristaltic waves, left The tenderness in the mid-abdomen did not touch the mass, and the back of the left back was full, with localized uplift, marked tenderness, and no significant fluctuations. Laboratory tests: Hb110g/L, RBC3.5×1012, WBC21.2×109 (N0.96, L0.04), tuberculin test negative B ultrasound: 10cm×6cm×3cm liquid dark area in the left lower back, within Irregular light echoes. The lumbar spine is normal. The hospital admission was left abscess abscess. On the second day, 10 ml of thin, slightly odorized pus was obtained by puncture, and abscess incision was performed under epidural anesthesia. See the back muscle clearance in the surgery with a 12cm x 8cm x 6cm abscess cavity. The aspirator draws a net pus. The bottom of the abscess cavity has a 0.7cm fistula. The stool overflows the stool and a piece of tissue is sent for inspection. The dry gauze packing is performed. Defecation from the wound after surgery. The disease examination showed a descending colon with poorly differentiated mucinous adenocarcinoma and extensive myometrial metastases. After full bowel preparation, laparotomy was performed under epidural anesthesia on the seventh day of hospitalization. Take the left lateral rectus incision, open the abdominal cavity, the descending colon has a narrow 4cm intestine shape, adhesion in the posterior abdominal wall, cut the side of the peritoneum, the ureter, free descending colon, forced separation of adhesions at the lesion, abscess Intercourse with the abdominal cavity. Exclusion of the left colon colon line, transverse colon, sigmoid end-to-end anastomosis, off?