Dubuisson V, Voïglio E J, Grenier N, Le Bras Y, Thoma M, Launay-Savary M V
Service de chirurgie vasculaire et générale, hôpital Pellegrin-Tripode, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
Unité de chirurgie d'urgence, faculté de médecine Lyon-Est UMR T9405, université de Lyon, université Claude-Bernard Lyon1, centre hospitalier Lyon-Sud, 69495 Pierre-Bénite cedex, France.
J Visc Surg. 2015 Dec;152(6 Suppl):S57-64. doi: 10.1016/j.jviscsurg.2015.09.019. Epub 2015 Oct 30.
Non-traumatic abdominal pathology is one of the most common reasons for consultation in emergency care services. Abdominal pain is the presenting symptom for many diseases, which often requires urgent care. Clinical history and physical examination are rarely sufficient to establish a definite diagnosis and imaging is usually necessary. The choice of imaging modality is oriented by the clinical context and guided by the institutional capabilities, safety and cost-effectiveness of the available tests. Plain radiographs have little or no place in the evaluation of the acute abdomen. Magnetic resonance imaging (MRI) still has limited availability in many hospitals, thus narrowing the imaging choice to ultrasound (US) and computerized tomography (CT). No scientific evidence exists to allow the imposition of one single strategy. At the present time, the clinician may choose either routine US evaluation complemented by CT in case the US is inconclusive or first-line CT (except for the evaluation of right lower quadrant [RLQ] pain, right upper quadrant [RUQ] pain and in pregnant women where ultrasound is the first-line study).
非创伤性腹部病变是急诊服务中最常见的会诊原因之一。腹痛是许多疾病的主要症状，往往需要紧急治疗。临床病史和体格检查很少足以明确诊断，通常需要影像学检查。影像学检查方式的选择取决于临床情况，并受机构能力、现有检查的安全性和成本效益的指导。普通X线平片在急腹症评估中作用很小或几乎没有作用。磁共振成像（MRI）在许多医院的可用性仍然有限，因此成像选择仅限于超声（US）和计算机断层扫描（CT）。目前尚无科学证据支持采用单一策略。目前，临床医生可以选择常规超声评估，若超声检查结果不明确则辅以CT检查，或者选择一线CT检查（右下腹[RLQ]疼痛、右上腹[RUQ]疼痛评估以及孕妇的检查除外，孕妇首选超声检查）。
