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患者男性,20岁,无明显诱因下突发上腹部阵发性剧痛1周,于1992年9月22日入院。该患者上腹部反复疼痛呈阵发性,发作时疼痛难忍,发作次数每天1～2次至6～7次不等,每次持续时间30分钟至3小时;发作时伴恶心,曾呕吐1次,为胃内容物。无畏寒、发热、黄疸。发作间歇略感腹胀和上腹部隐痛。发病后2～3天排便1次,成形色黄。入院前1周内曾在杭州市几家医院门诊4～5次,B超检查示胆囊多发性息肉;胃肠造影示轻度胃下垂;上腹部CT检查:无异常发现;血常规:白细胞9×10~9/L,其中中性粒细胞0.8、淋巴细胞0.12、嗜酸性粒细胞0.08.初诊:“急性胃炎,胆囊炎,胆道蛔虫症。”经反复抗炎、止痉等输液治疗,症状未改善。后收住本院内科,在疼痛发作期间2次尿卟胆原化验呈阳性,确诊为“肝性卟啉病,急性间歇型”。此后给氯丙嗪25mg、每日3次治疗。2天后疼痛发作次数减少,1周后停止。在腹痛缓解期复查尿卟胆原化验呈阴性。经出院后随访,患者遵医嘱,忌酒、忌巴比妥类药、避免饥饿和精神刺激等诱发因素,已8个月未再复发。
Male patient, 20 years old, without obvious incentive to burst paroxysmal abdominal pain for 1 week, was admitted on September 22, 1992. Repeated pain in the abdomen of the patient was paroxysmal, the onset of pain, the number of attacks 1-2 times a day to 6 to 7 times, each duration of 30 minutes to 3 hours; attack with nausea, vomiting 1 Times, for the stomach contents. No chills, fever, jaundice. Intermittent sedation slightly abdominal distension and abdominal pain. 2 to 3 days after onset defecation 1, forming yellow color. Within 1 week before admission, several hospitals in Hangzhou City, outpatient 4 to 5 times, B ultrasound showed gallbladder polyps; gastrointestinal angiography showed mild gastroptosis; upper abdominal CT examination: no abnormalities found; blood: white blood cells 9 × 10 ~ 9 / L, of which 0.8 neutrophils, lymphocytes 0.12, eosinophils 0.08. New diagnosis: “Acute gastritis, cholecystitis, biliary ascariasis.” After repeated anti-inflammatory, antispasmodic infusion therapy, symptoms improve. After receiving our hospital medicine, 2 episodes of urinary porphyrin were positive during the episode of pain and were diagnosed as “hepatic porphyria, acute intermittent.” After chlorpromazine 25mg, 3 times a day treatment. Pain episodes decreased after 2 days and stopped after 1 week. In the remission of abdominal pain urinary porphyria review of the original test was negative. After follow-up after discharge, the patient prescribed medicine, avoid alcohol, avoid barbiturates, avoid hunger and mental stimulation and other triggers, has not relapsed in 8 months.