CT＼hs-CRP检查结果对腹痛待查患者早期腹腔镜影响诊治效果的

CT scan and serum hs-CRP test prior to laparoscopic exploration for patients with acute abdomen

目的探讨对非弥漫性腹膜炎腹痛待查患者行早期腹腔镜探查术前检查CT、hs-CRP的必要性。方法将无弥漫性腹膜炎体征．门急诊初步检查后未能明确诊断的146例腹痛待查患者，入院后按CT、hs-CRP检查结果分为4组：A组为对照组，腹部CT检查无阳性发现，hs-CRP在正常范围；B组为CT有阳性发现，hs-CRP在正常范围；C组CT无阳性发现，hs-CRP升高；D组为CT有阳性发现，hs-CRP升高。均在入院24h内行早期腹腔镜探查术，比较4组患者的术中确诊率、治愈率、手术中处理率、住院时问以及患方满意度。结果B、C、D组的术中确诊率、治愈率、患方满意度等均优于A组（均P〈0，05）；D组的术中处理率高于A组（P〈005），但B、C两组的术中处理率与A、D两组相比差异均无统计学意义（均P〉0．05）；D组的术中确诊率、治愈率、患者满意度、住院时间与B、C两组相仿（均P〉0．05）。在住院时间上B、C、D3组与对照组相比差异均无统计学意义（均P〉O．05）。结论术前CT、hs-CRP检查的结果在较大程度上影响腹腔镜探查的效果，非弥漫性腹膜炎的腹痛待查患者行早期腹腔镜探查前有做CT、hs-CRP检查的必要。

Objective To evaluate the application of CT scan and serum high sensitivity-C reaction protein （hs-CRP） test prior to laparoscopic exploration for patients with acute abdomen. Methods One hundred and forty six patients with acute ab- domen, in whom diffuse peritonitis was excluded, were enrolled in the study. Patients were divided into 4 groups according to the abdominal CT findings and serum hs-CRP levels： group A with both negative CT findings and normal hs-CRP levels, group B with positive CT findings and normal hs-CRP, group C with negative CT findings and high hs-CRP level and group D with bothpositive CT findings and high hs-CRP levels. The laparoscopic exploration was performed within 24 h after admission. The intra- operative diagnosis rate, cure rate, intraoperative procession rate, length of hospital stay and patient satisfaction were compared among 4 groups. Results The intraoperative accurate diagnosis rate, cure rate and patient satisfaction of group B, C and D were higher than those of group A（P〈0.05）.The intraoperative procession rate of group D was higher than group A（P〈0.05）, but there were no statistical differences among other groups（P 〉0.05）. There were no significant differences in intraoperative diagnosis rate, cure rate, patient satisfaction and length of hospital stay among groups B, C and D（P 〉0.05）. There was no significant difference in length of hospital stay among all groups（P 〉0.05）. Conclusion The preoperative CT examination and serum hs-CRP test may be beneficial to laparoscopic exploration in patients with non-diffuse peritonitis acute abdomen.