青岛英华外语学校http://www.qdyinghua.com青岛英华外语学校http://www.qdyinghua.comChapter45AcuteAbodomen-DecisiontoOperate�Thesedifficultiesnotwithstanding,thesurgeonmustmakeadecisiontooperateornot.Certainindicationsforsurgicaltreatmentexist.�Notwithstanding尽管虽然�尽管有这些困难，外科医生必须作出是否手术的选择。有一些外科手术的指征。�Forexample,definitesignsofperitonitissuchastenderness,guarding,andreboundtendernesssupportthedecisiontooperate.�Peritonitis腹膜炎�比如说，特定的腹膜炎体征如腹痛，肌卫，反跳痛都支持手术的决定。�Likewise，severeorincreasinglocalizedabdominaltendernessshouldpromptanoperation.�同样的，严重的或者逐渐加重的局限性腹痛也应马上手术。�Patientswithabdominalpainandsignsofsepsisthatcannotbeexplainedbyanyotherfindingshouldundergooperation.�无法解释的腹痛伴随脓毒症的病人应该进行手术。�Thosepatientssuspectedofhavingacuteintestinalischemiashouldbeoperatedonaftercompleteevalution.�对怀疑肠缺血的病人需进行充分评估后手术。�Certainradiogragphicfindingsconfidentlypredicttheneedforoperation.�某些诊断学的发现比较确切地提示了手术指证。�Thesefindingincludepneumoperitoneumandradiologicevidenceofgastrointestinalperforation�这些发现包括气腹证或者胃肠穿孔的放射学证据。�Patientspresentingwithabdominalpainandfreeintra-abodominalgasseenonradiographwarrantoperationwithlimitedexceptions.�如果患者有腹痛并且X光片上有腹腔内气体，绝大部分病人需要手术。�Observationwithserialexaminationsmaybeappropriateforapatientwithfreegasafteracolonoscopy.�结肠镜检查后出现自由气体的病人需要观察并做一系列的检查。�Intra-abdominalgascanpersistforadayortwofollowingceliotomy.�剖腹术后腹腔内气体还可以遗留一至二天。�Imagingtestscanrevealsignsofvascularocclusionrequiringoperation.�放射学检查可以提示需要手术的血管阻塞疾病。�Aftercarefulexaminationandevaluation,diagnosticuncertaintycanremain.Somepatientsmayhaveequivocalphysicalfindings.�详细的检查和评估之后，诊断未明确的可以继续观察。一些病人可能表现出模棱两可的体征。�Whenthisoccursandthediagnosisisunclearandthepatientswellnessisunclear,itmaybeadvisabletodeferoperationandtore-examinethepatientcarefullyafterseveralhours.�如果有上述情况，诊断不明确，病人症状无好转，建议延期手术，数小时后再次详青岛英华外语学校http://www.qdyinghua.com青岛英华外语学校http://www.qdyinghua.com细检查。Thisisbestdoneinashort-stayunitinthehospital,inaspecialunitintheemergencydepartment,orifnecessary,byregularhospitaladmission.�最好能在医院短期留观或者在急诊室观察，如果有必要可以入院观察。�Inaperiodofhours,vaguepainwithminimalphysicalfindingsmayproceedtodefinitelocalizedpainwithtenderness,guarding,andreboundtenderness;ifthatoccurs,operationshouldfollow�如果在数小时内，没有明显体征的腹胀转化为明确的局限性腹痛，肌卫和反跳痛，则手术指证明显。�Afterseveralhours,thepatient’ssymptomsandsignsmayalsoresolve.�也有可能，数小时后病人的症状和体征消失。�Whenthathappens,thepatientcanbedismissed,althoughthepatientshouldhaveafollow-upappointmentscheduledwithinadayorsotopermitre-examinationtobecertainthatanimportantdiagnosiswasnotmissed.�如果是这种情况，病人可以出院，虽然仍需短期的随访和重新检查，以免遗漏重要的诊断。�Certainpatientsaredifficulttoevaluatebecauseofspecialcharacteristics.�有些病人由于特殊性很难评估。�Forexample,patientswhoareneurologicallyimpairedasresultofstrokeoraspinalcordinjurymaybedifficulttoevaluate.�如由于中风或脊髓损伤导致的神经系统功能...
