胰腺疾患误诊为泌尿系结石5例分析.docVIP

胰腺疾患误诊为泌尿系结石5例分析 李涛(通讯 )吴翔 张弛 吴进锋 余澄波 尚华辉 (福建医科大学省立临床学院/福建省立医院泌尿外科福建福州 350001) 【 】目的：分析胰腺疾患误诊为泌尿系结石的常见原因。方法：对木 院近10年收治的首诊误诊为泌尿系结石的5例胰腺疾病患者的临床资料进行回 顾性分析。结果：4例急性胰腺炎误诊为左上尿路结石，1例胰管结石误诊为右 肾结石，均有明显的腰痛，伴有不同程度的上腹痛、恶心、呕吐、腹胀等腹部症 状，误诊时间2?4天，3例治愈，2例重症胰腺炎死亡。结论：对临床疑诊为泌 尿系结石的腰痛或急性肾功能衰竭患者，如伴有难以解释的腹部症状，尤其是以 上腹痛起病者，要考虑到急性胰腺炎等胰腺疾患的可能性；对泌尿系结石患者行 ESWL或手术治疗之前应常规进行IVU检查。 【关键词】胰腺炎；泌尿系结石；误诊 【中图分类号】R657.5 【文献标识码】A 【文章编号】2095-1752 (2015) 21-0179-03 Pancreatic disorders misdiagnosed as urinary lithiasis (5 cases report) Li Tao, Wu Xian匕 Zhang Chi, Wu Jinfeng, Yu Chengbo, Shang Huahui. Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, 350001, China 【Abstract] Objective To analyze the causes of misdiagnosis of pancreatic disorders as urinary lithiasis. Methods The clinical data of 5 cases of pancreatic disorders misdiagnosed as urinary lithiasis in our hospital in the recent decade were reviewed. Results 4 cases of acute pancreatitis with left lumbago were misdiagnosed as lithiasis of left upper urinary tract, and a case of pancreatic duct stone was misdiagnosed as right renal stone. All the 5 cases had some abdominal symptoms such as pain in the upper abdomen, nausea, vomiting and abdominal distension. The misdiagnoses lasted 2-4 days when the correct diagnoses were made. 3 cases survived, and 2 cases of severe pancreatitis died eventually. Conclusions For a patient previously diagnosed urinary lithiasis because of lumbago or acute renal failure, the diagnosis of acute pancreatitis should be also suspected if there are inexplainable abdominal symptoms, especially when the pain rises from the upper abdomen. Intravenous urography should be routinely carried out for the patients with urinary lithiasis who is ready to receive extracorporeal shockwave lithotripsy or surgical treatment. 【Key words] Pancreatitis; Urinary lithiasis; Diagnostic errors 胰腺与肾输尿管同属腹膜后器官，其发生病变的临床表现多种多样，有时症 状与泌尿系疾病相似，容易发生误诊误治。本院泌尿外科近10年收治首诊误诊 为泌尿系结石的急性胰腺炎患者4例和胰管结石患者1例，现结合临床资料作一 分析报告。 1 ?病例报告 例1男，68岁。因左腰部疼痛1天入