小儿阑尾炎误诊分析及应对的策略.docVIP

小儿阑尾炎误诊分析及应对的策略 　　【摘要】目的:分析小儿阑尾炎误诊原因，提出避免误诊的应对策略。方法:报告本院10年来首诊其他疾病而后经手术证实为阑尾炎的小儿患者109例,对病史、相关检查结果、手术所见进行回顾性分析。结果:109例中首诊拟急性胃肠炎治疗32 例,肠系膜淋巴结炎28例,胃肠型感冒13例,肠痉挛12例，肠套叠6例,肺炎及细菌性痢疾各4例,肠结核2例,原发性腹膜炎,卵巢囊肿蒂扭转及肠蛔虫症各2例，腹型紫癜1例，肠梗阻1例。结论: 详细的病史询问，完善的体格检查，合理的辅助检查，医生强烈的责任心可有效降低小儿阑尾炎误诊率。对酷似阑尾炎且具备手术指征者，应早期手术探查，允许阑尾炎误切，可最大限度地降低小儿阑尾炎的并发症。 　　【关键词】小儿; 阑尾炎; 阑尾切除术; 诊断 　　【中图分类号】R447 【文献标识码】A 【文章编号】1008-6455（2011）12-0510-02 　　The misdiagnosing analysis and the dealing strategies for pediatric appendicitis 　　Li Jian Zhu Jifeng 【Abstract】Objective: To investigate the misdiagnosing causes of pediatric appendicitis and propose the dealing strategies for the misdiagnosis Methods：109 cases of pediatric appendicitis confirmed by surgical operation but first diagnosed other disease were reported in recent 10 years， their history, relative results of adjunct medical examination,and operative findings were retrospectively analysed. Results： Among the 109 cases，first diagnosed acute gastroenteritis were 32 cases,mesenteric lymphadenitis 28 cases,gastrointestinal type influenza 13, intestinal spasm 12,intussusception 6,pneumonia and bacterial dysentery 4 cases respectively,intestinal tuberculosis 2, primary peritonitis， ovarian cyst torsion and intestinal ascariasis 2 cases respectively,abdominal purpura 1,intestinal obstruction 1. Conclusions： Detailed history,complete physical examinations,reasonable auxiliary examinations and the strong responsibilities of medical admissions could reduce the misdiagnosis rate of pediatric appendicitis. For resembling appendicitis who have surgical indications,surgical operation should be done early.Allowed mistaking appendectomy could lower maximally the complications of pediatric appendicitis. 　　【Key words】children;appendicitis; appendectomy;diagnosis 　　小儿阑尾炎是儿童最常见的急腹症之一,约占小儿腹部外科急腹症总数的25%〖1〗。由于小儿阑尾炎病史往往提供不清，症状体征不典型,体检多不合作, 易误诊漏诊,延误病情，产生阑尾穿孔腹膜炎等并发症。从2001年2月至2010年3月，我科治疗本院及外院首诊误诊，后经手术证实的小儿阑尾炎109例，临床资料报告如下。 　　1 临床资料 　　1.1 一般资料: 本组109例,其中男性65例,女性44例。年龄平均10.4 岁,