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回盲部结肠癌误诊为阑尾炎30例分析

【摘要】　目的　分析回盲部结肠癌误诊为阑尾炎的原因及如何避免误诊的方法。　方法　回顾性分析1998年1月－2010年10月误诊为阑尾炎的回盲部结肠癌患者30例的临床资料。其中男24例，女6例；年龄14～78岁，平均56岁。30例患者均行手术治疗，阑尾切除术中发现回盲部结肠癌28例而改行其他术式，其中一期右半结肠癌根治术12例，姑息性右半结肠切除术5例，回肠横结肠短路术6例，二期手术5例；1例于阑尾切除术后15 d发现回盲部结肠癌，行右半结肠癌根治术；1例于阑尾切除术后6个月因肠梗阻明确诊断而再次手术，行右半结肠癌根治术。20例术后行全身静脉联合化学疗法治疗。　结果　术后发生切口感染6例，经局部换药、抗感染及支持等治疗后切口丙级愈合；其余切口均甲级愈合。术后无肠漏发生。住院时间12～68 d，平均18 d，住院期间无死亡者。所有患者术后病理检查均证实为回盲部结肠腺癌，其中合并阑尾炎28例。20例获随访，随访时间3个月～12年，平均5.6年。6例因无法切除病灶而行回肠横结肠吻合短路手术，于术后6～15个月死亡；5例行姑息性右半结肠切除术，于术后9～27个月死亡；余9例随访2～12年无复发。同期收治回盲部结肠癌167例，误诊、漏诊率为18%。　结论　回盲部结肠癌有时易误诊为阑尾炎，或并发阑尾炎时易漏诊；应仔细询问病史，全面了解和掌握患者的病情，完善必要的辅助检查，不要盲目自信是防止误诊、漏诊的关键。

脉络膜血管瘤误诊三例分析

报告3例误诊的脉络膜血管瘤，本病容易漏诊、误诊，除与其本身特点有关外，主要是由于医生对本病缺乏认识，检查不全所致。 （中华眼底病杂志，1994，10：44-45）

动脉导管未闭合并其他心脏畸形的临床分析

目的 探讨动脉导管未闭(PDA)合并其他心脏畸形的外科治疗经验. 方法 回顾性分析106例PDA合并其他心脏畸形的临床特点、手术方式与转归. 结果 死亡9例,住院死亡率8.5%,体外循环(CPB)前发现PDA与CPB后发现,住院死亡率差别有显著性意义(χ2＝6.383,Plt;0.05);术后发生并发症40例,术前漏诊与确诊PDA患者并发症的发生率差别有显著性意义(χ2＝5.388,Plt;0.05). 结论 在室间隔缺损、房间隔缺损、主动脉瓣或瓣下病变、主动脉缩窄、法洛四联症等心脏畸形进行手术治疗时,应特别注意是否合并PDA.提高术前及CPB前PDA诊断水平,对降低住院死亡率及并发症发生率具有重要意义.

The Preventive Measures of Misdiagnosis and Missing Diagnosis of Blunt Abdominal Trauma

Objective To investigate the reasons of misdiagnosis and missing diagnosis in blunt abdominal trauma (BAT), and to put forward effective preventive measures. Methods Literature on BAT diagnosis in recent years was reviewed. Results Misdiagnosis and missing diagnosis, which can take place in every segment of BAT patients, were still quite common nowadays. Conclusion Detailed case history collecting, faithful medical examination and making good use of assistant examinations can efficiently decrease the misdiagnosis and missing diagnosis rates of BAT patients.

中间葡萄膜炎误漏诊病例分析

报告24例中间葡萄膜炎的误诊、漏诊病例，其中双眼患者19例。误诊、漏诊时间平均1年9个月。分析本病容易误诊和漏诊的原因除与本病自身的特点有关外，尚与医生对本病重视不够、认识不足和临床检查不全有很大关系。 （中华眼底病杂志，1993，9：87-88）

Reasons of Missed Diagnosis and Misdiagnosis of Glandularis Cystitis by Ultrasonography

【摘要】　目的　分析超声对腺性膀胱炎的误、漏诊原因，探讨减少其误、漏诊的方法。　方法　回顾性分析2006年1月-2010年2月经病理证实的135例腺性膀胱炎的声像图表现。　结果　135例腺性膀胱炎患者中，超声误诊26例，误诊率19.3%，漏诊11例，漏诊率8.2%。误诊的主要原因：乳头结节型和团块型与膀胱肿瘤声像图极为相似、容易混淆，超声医师对膀胱壁各层次的观察不仔细，对病史重视不够；漏诊的主要原因：膀胱充盈不佳或不充盈，病变体积太小、位于前壁或顶部，或病变位于膀胱后壁及颈部被明显增生的前列腺、膀胱内血凝块及膀胱结石等掩盖。　结论　超声是诊断腺性膀胱炎常用方法，但存在一定的误、漏诊，改进检查方法，可减少其误、漏诊发生。【Abstract】　Objective　To analyze the reasons of missed diagnosis and misdiagnosis of glandularis cystitis by ultrasonography.　Methods　The sonographic outcomes of 135 patients with glandular cystitis diagnosed by pathological examination from January 2006 to February 2010 were retrospectively analyzed.　Results　In 135 patients, misdiagnosis was in 26 with a rate of 19.3%, missed diagnosis was in 11 with a rate of 8.2%. The reasons of misdiagnosis included: the sonographic outcomes of mastoid and tuberculous conglomeration were similar to those of bladder tumour; the ultrasonographic professionals didn’t clearly observe each layer of the bladder wall, and didn’t pay enough attention to the disease history. The reasons of missed diagnosis included: the bladder was under-filled or unfilled, the size of the lesions were too small and were located at the anterior wall or the top, and the lesions were located at the posterior wall and neck of the bladder which were covered up by obvious prostate hyperplasia,and gores or stones of bladder so that the lesions could not be observed.　Conclusion　Ultrasonography is a usual method for diagnosing glandular cystitis,and we should ameliorate the examination to decrease the misdiagnosis and missed diagnosis.

急性主动脉夹层伴多器官灌注不良综合征一例

Analysis of Missed Diagnosis of Cervical Cancer

目的　探讨宫颈癌漏诊的原因及特点，提高首诊诊断率。 方法　回顾性分析2009年1月－2011年3月收治的外院漏诊的65例宫颈癌患者临床资料。 结果　漏诊的65例中有51例误诊为宫颈糜烂，其中仅13例首诊曾行细胞学筛查，16例行阴道镜检查及活检，总平均年龄仅39岁，农村居民54例。 结论　各地区应加强宫颈癌筛查意识，采取相应措施及适合的筛查方式提高宫颈癌筛查率，减少漏诊。

Missed Diagnosis of Sleep Apnea Hypopnea Syndrome: Analysis of 42 Cases and Literature Review

Objective To analyze the causes of missed diagnosis of sleep apnea hypopnea syndrome ( SAHS) . Methods 42 missed diagnosed cases with SAHS from May 2009 to May 2011 were retrospectively analyzed and related literatures were reviewed. Results The SAHS patients often visited the doctors for complications of SAHS such as hypertension, diabetes mellitus, metabolic syndrome, etc. Clinical misdiagnosis rate was very high. Lack of specific symptoms during the day, complicated morbidities, and insufficient knowledge of SAHS led to the high misdiagnosis rate and the poor treatment effect of patients with SAHS. Conclusion Strengthening the educational propaganda of SAHS, detail medical history collection, and polysomnography monitoring ( PSG) as early as possible can help diagnose SAHS more accurately and reduce missed diagnosis.

ANALYSIS OF MISSED DIAGNOSIS IN COLORECTAL CANCER (REPORT OF 380 CASES)

Objective To analyse the causes of missed diagnosis in colorectal cancers and improve the early diagnosis. Methods A retrospective analysis was made to investigate the cause of missed diagnosis in 380 cases suffering from colorectal cancers.Results Of the 1 020 patients treated in our hospital in the past ten years (1984-1993), 380 patients were missed diagnosed, with the missed diagnosis rate of 37.3%. The main causes included: ①lacking attention to the early symptoms of colorectal cancers, neglecting the need to conduct certain tests such digital rectal examination and stool occult blood examination, ②delaying of seeking medical advice on the part of the patients, ③being satisfied with the diagnosis and treatment of benign disease, and ④neglecting certain special tests such as enteroscopy and barium enema examination of colon.Conclusion Routine use of rectal touch, occult blood examination and necessary use of special tests such as enteroscopy, barium enema examination of colon in patients suffering from stool change will increase the rate of accurate diagnosis of colorectal cancer.