全身性紅斑狼瘡併發急性外科性腹症

Acute Surgical Abdomen in Systemic Lupus Erythematosus

全身性紅斑狼瘡可併發和疾病本身有關之急性腹症以及和疾病無關之急性腹症，兩者常常不易鑑別診斷，而且治療方法完全不周。我們分析十一例經手術證實之紅斑性狼瘡併發急性腹症案例，發現四例和疾病本身有關（兩例狼瘡性漿膜炎、兩例腸血管炎），而另有七例則和疾病無關之急性腹症。手術前之評估包括臨床症狀、理學檢查、實驗診斷學檢查及照影檢查皆無法鑑別診斷與疾病本身有關或是無關之急性腹症。在高活動性紅斑狼瘡病人中，併發與疾病本身有關之急性腹症的機率較大。於兩日內進行手術治療者皆存活，兩日後才手術者有67％的死亡率。我們建議在一位高活動性紅斑狼瘡病人併發急性腹症，在早期尚無法正確診斷但可排除腸管破裂時，可先給予大劑量類固醇治療，如經過12～48小時仍未見好轉或更惡化時，必須做手術治療。對於低活動性紅斑狼瘡病人，如發生進展快速的急性腹症，則手術是首選治療。

Patients with systemic lupus erythematosus (SLE) may be complicated with acute abdomen (AA) which is SLE-related or non-SLE-related. It is difficult to differentiate one from another and the management of the two conditions is totally different. We analyzed 1lcases of SLE with surgically proven AA including 4 SLE-related AA (2 lupus serositis, 2 mesenteric vasculitis) and 7 non-SLE-related AA. Preoperative investigations of AA included clinical symptoms, physical findings, laboratory findings and imaging studies. However, all of these evaluations could not distinguish SLE-related from non-SLE-related AA. All of the patients who received operation in 2 days survived while 67% died if the operation was delayed after 2 days. We suggest that a large dose of steroid should be tried as soon as possible once bowel perforation is ruled out in active SLE patients with AA (SLEDAI> 5). If there is no improvement or even deterioration in 12 to 48 hours after steroid treatment, laparotomy should be performed. In addition, for those inactive SLE patients (SLEDAI< 5) who developed AA with a rapid course, surgery is the treatment of choice.