Suleiman S, Johnston D E
University of New Mexico School of Medicine, Albuquerque, USA.
Am Fam Physician. 2001 Aug 1;64(3):431-8.
When abdominal pain is chronic and unremitting, with minimal or no relationship to eating or bowel function but often a relationship to posture (i.e., lying, sitting, standing), the abdominal wall should be suspected as the source of pain. Frequently, a localized, tender trigger point can be identified, although the pain may radiate over a diffuse area of the abdomen. If tenderness is unchanged or increased when abdominal muscles are tensed (positive Carnett's sign), the abdominal wall is the likely origin of pain. Most commonly, abdominal wall pain is related to cutaneous nerve root irritation or myofascial irritation. The pain can also result from structural conditions, such as localized endometriosis or rectus sheath hematoma, or from incisional or other abdominal wall hernias. If hernia or structural disease is excluded, injection of a local anesthetic with or without a corticosteroid into the pain trigger point can be diagnostic and therapeutic.
当腹痛为慢性且持续不缓解，与进食或肠道功能关系极小或无关，但常与姿势（即躺卧、坐立、站立）有关时，应怀疑腹壁是疼痛的来源。通常，虽然疼痛可能会扩散至腹部的一个弥漫区域，但可以确定一个局部的、有压痛的触发点。如果腹部肌肉紧张时压痛无变化或加重（卡内特征阳性），则腹壁很可能是疼痛的起源。最常见的是，腹壁疼痛与皮神经根刺激或肌筋膜刺激有关。疼痛也可能由结构性疾病引起，如局部子宫内膜异位症或腹直肌鞘血肿，或由切口疝或其他腹壁疝引起。如果排除了疝或结构性疾病，在疼痛触发点注射局部麻醉剂（可加或不加皮质类固醇）可起到诊断和治疗作用。
