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临床对黄疸的诊断有不少实际问题,长期认识不清,甚而延误诊断,造成严重后果。因而有必要从不同角度进行探讨。黄疸并非独立疾病,各科的许多疾病可引起黄疸,各种感染,低血压、休克,缺氧,药物、输血也可引起黄疸。因此,临床上见到黄疸,应根据病情全面分析,决不可发现黄疸就诊断为肝炎。黄疸发病原因不同,机制不同,临床表现也各不相同。多数病例诊断并不困难,少数病例则十分不易。对黄疸缺乏正确的鉴别诊断,则可导致错误诊治。例如将慢性肝病无准备的滥施剖腹手术,可造成严重后果,据统计肝硬变者死亡率可达15～35%,急性肝炎或暴发型肝炎则高达100%。反之,总胆管完全硬阻,若长期拖延不施行手术,可致肝脏不同程度的继发性损伤,甚而形成继发性胆汁性肝硬变。提高对黄疸的诊断水平,对于早期正确治疗,仍然是目前非常重要的课题。因此本刊特委托河南医学院段芳龄副教授主持此次讨论。
Clinical diagnosis of jaundice has many practical problems, long-term understanding is not clear, and even delay diagnosis, resulting in serious consequences. It is necessary to explore from different angles. Jaundice is not an independent disease, many diseases in various subjects can cause jaundice, various infections, hypotension, shock, hypoxia, drugs, blood transfusion can also cause jaundice. Therefore, clinically see jaundice, should be based on a comprehensive analysis of the disease, jaundice should not be found on the diagnosis of hepatitis. Different causes of jaundice, different mechanisms, clinical manifestations are also different. Diagnosis of most cases is not difficult, a few cases are not easy. The lack of a correct differential diagnosis of jaundice can result in misdiagnosis. For example, chronic liver disease without laxative laparotomy, can have serious consequences, according to the statistics of cirrhosis mortality up to 15 to 35%, acute hepatitis or fulminant hepatitis is as high as 100%. On the contrary, the total bile duct completely hard resistance, if prolonged delay without surgery, can cause varying degrees of liver secondary injury, and even the formation of secondary biliary cirrhosis. To improve the diagnosis of jaundice, for the early correct treatment, is still a very important issue. Therefore, this publication commissioned the Associate Professor Duan Fangling Henan Medical College presided over the discussion.