Paterson-Brown S, Vipond M N
Ashford Hospital, Middlesex, UK.
Br J Surg. 1990 Jan;77(1):13-8. doi: 10.1002/bjs.1800770105.
Acute abdominal pain continues to provide not only a large workload for the general surgeon but also many diagnostic and management problems. Many different techniques have been introduced over the past two decades to help in the management of the acute abdomen and this review considers their relative claims to become incorporated into the process of clinical decision-making. The evidence in support of formally structured patient interview pathways with or without computer-aided diagnostic programs is now overwhelming and should become routine. Both laparoscopy and peritoneal cytology have an important role to play in the management of patients in whom the decision to operate is in doubt, and a combination of the two would be complementary. Ultrasonography has become increasingly popular for investigating the acute abdomen, and results from specialist centres are impressive. However, the problems of operator variation and the difficulties in providing a 24-h service will probably prevent it from becoming a first-line investigation in most hospitals. Although plain radiography has been available for many years, its routine use in the management of the acute abdomen remains controversial. Recent studies have confirmed that contrast radiography is an important adjunct to decision-making, particularly in the management of large bowel obstruction, and there is increasing evidence to support its use in suspected small bowel obstruction, perforated peptic ulcer and acute diverticular disease.
急性腹痛不仅持续给普通外科医生带来大量工作，还引发诸多诊断和处理难题。在过去二十年里，已引入许多不同技术来辅助急性腹痛的处理，本综述探讨了它们在临床决策过程中被纳入的相关依据。支持采用有或没有计算机辅助诊断程序的正式结构化患者访谈路径的证据现已极为充分，应成为常规做法。腹腔镜检查和腹腔细胞学检查在对是否进行手术存在疑问的患者的处理中都发挥着重要作用，二者结合将具有互补性。超声检查在急性腹痛检查中越来越受欢迎，专科中心的检查结果令人印象深刻。然而，操作人员差异问题以及提供24小时服务的困难可能会阻碍其在大多数医院成为一线检查手段。尽管普通X线摄影已应用多年，但其在急性腹痛处理中的常规使用仍存在争议。近期研究证实，对比造影是决策的重要辅助手段，尤其在大肠梗阻的处理中，而且越来越多的证据支持其在疑似小肠梗阻、消化性溃疡穿孔和急性憩室病中的应用。
