右半结肠癌并发急性阑尾炎漏诊结肠癌原因分析.doc

右半结肠癌?并发急性阑?尾炎漏诊结?肠癌原因分?析 朱广利 浙江大学医?学院附属第?一医院普外?科 ▲现在滨江区?长河街道社?区卫生服务?中心外科 【摘要】目的 探讨结肠癌?伴发急性阑?尾炎漏、误诊结肠癌?的原因。方法 对6年来结?肠癌伴发急?性阑尾炎的?28例患者?进行回顾性?分析。结果 28例结肠?癌伴发急性?阑尾炎患者?26例行急?诊手术，术中确诊1?0例，漏诊16例?。右半结肠癌?根治术14?例，姑息性切除?术10例，短路手术3?例。结论 对急腹症表?现的结肠癌?，临床医师缺?乏足够的认?识和了解。对于阑尾炎?诊断有疑问?者，应详细检查?并行术中探?查，以免漏诊。对于阑尾切?除术后仍有?腹痛的病人?，应给予仔细?检查，排除结肠肿?瘤。 【关键词】右半结肠癌? 急性阑尾炎? 漏/误诊 Zhugu?angli? The First? Affil?iated? Hospi?tal Of zheji?ang Unive?rsity? 31000?0 [Abstr?act] Objec?tive to study? the cause? of misdi?agnos?is when ascen?ding colon? cance?r is compl?icate?d by acute? appen?dicit?is. Metho?ds A retro?spect?ive revie?w was condu?cted of 28 cases? of ascen?ding colon? carci?noma compl?icate?d by acute? appen?dicit?is from 1988 to 1999 in our hospi?tal. Resul?ts 26 cases? of them were done by acute? opera?tion. 10 cases? were diagn?osed durin?g the opera?tion, but 16 cases? were misdi?agnos?ed. 14 cases? were done by the ascen?ding colon? opera?tion, 10 cases? by palli?ative? opera?tion. Concl?usion? Surge?ons are lack of the exper?ience? for the ascen?ding colon? carci?onma when the sympt?om is acute? appen?dicit?is with surgi?cal abdom?en. To avoid? misdi?agnos?is, we shoul?d exami?ne caref?ully, and then check? up dunin?g opera?tion when the diagn?osis of acute? appen?dicit?is is uncer?tain. We shoul?d also be caref?ul for the patie?nt who stil have the pain after? the appen?decto?my, exami?ning in order? to exclu?de the possi?bilit?y of ascen?ding colon?.l [Key words?] Ascen?ding colon? cance?r Acute? appen?dicit?is Misdi?agnos?is 结肠癌是消?化道常见恶?性肿瘤，且近年来发?病率呈明显?上升趋势。右半结肠癌?在结肠癌中?占有一定比?例，由于右半结?肠癌病人早?期临床表现?并不典型，并发不全梗?阻时有阵发?性腹痛，容易与阑尾?炎相混淆。我科自20?03年～2008年?共有28例?右半结肠癌?误诊为急性?阑尾炎、2例误诊为?阑尾包块，占同期结肠?癌病例的7?.7%。26例急诊?手术。本文回顾总?结了28例?右半结肠癌?漏、误诊原因。 1 临床资料 1.1 一般情况 本组28例?，男19例，女9例，年龄为24?～92岁，平均64.45岁。50岁以上?24例，占87%：其中有腹部?手术史者4?人。临床表现：19例发病?时间为12?～48小时，14例表现?为典型的转?移性右下腹?痛；4例为右下?腹痛阵发性?加重。非典型症状?10例，为右下腹隐?痛反复发作?，腹胀或大便?次数增多；时间为十三?天至三月，均因腹痛加?重就诊，其中4例伴?有发热。体检：本组病人均?有右下腹压?痛，其中12例?伴有肌紧张?，8例伴有反?跳痛；2例触及