CAJ | 학술논문

目的了解我国急件胰腺炎(acute pancreatitis,AP)的误诊现状,提高对AP的诊断意识.方法通过中国期刊伞文数据库(CNKI网络版)检索1988年～2007年问发表与AP误诊有关的病例研究报告144篇,对被误诊的1098例AP患者的误诊疾病、临床表现、危险因素、辅助检查、确诊方法等进行回顾性研究.结果 (1)AP患者被误诊疾病多种多样,前5位依次是胆石症合并胆系感染(182例)、急性胃肠炎(158例)、急性阑尾炎(102例)、消化性溃疡(94例)、肠梗阻(90例);(2)患者最主要的临床表现是腹痛(878例),依据腹痛部位依次为中上腹痛(434例)、全腹痛(220例)、右下腹痛(79例)、右上腹痛(74例)、左上腹痛(71例)等;(3)胆囊结石是危险因素中占首位,为145例,其他依次为脂餐饮食(106例)、慢性胆囊炎(72例)和饮酒(67例)等;(4)依靠手术确诊的病例占首位,为378例,其他依次为淀粉酶(351例)、腹部CT(135例)、腹部B超(59例)等.结论 (1)对危险因素认识不足、临床表现缺乏全面正确分析,辅助检杏缺乏客观判断是误诊的主要原因;(2)动态血尿淀粉酶仍是诊断急性胰腺炎的主要方法,但有其局限性;对于不能确诊而高度怀疑者应及时行腹部CT或剖腹探查以明确诊断.
목적 료해아국급건이선염(acute pancreatitis,AP)적오진현상,제고대AP적진단의식.방법 통과중국기간산문수거고(CNKI망락판)검색1988년～2007년문발표여AP오진유관적병례연구보고144편,대피오진적1098례AP환자적오진질병、림상표현、위험인소、보조검사、학진방법등진행회고성연구.결과 (1)AP환자피오진질병다충다양,전5위의차시담석증합병담계감염(182례)、급성위장염(158례)、급성란미염(102례)、소화성궤양(94례)、장경조(90례);(2)환자최주요적림상표현시복통(878례),의거복통부위의차위중상복통(434례)、전복통(220례)、우하복통(79례)、우상복통(74례)、좌상복통(71례)등;(3)담낭결석시위험인소중점수위,위145례,기타의차위지찬음식(106례)、만성담낭염(72례)화음주(67례)등;(4)의고수술학진적병례점수위,위378례,기타의차위정분매(351례)、복부CT(135례)、복부B초(59례)등.결론 (1)대위험인소인식불족、림상표현결핍전면정학분석,보조검행결핍객관판단시오진적주요원인;(2)동태혈뇨정분매잉시진단급성이선염적주요방법,단유기국한성;대우불능학진이고도부의자응급시행복부CT혹부복탐사이명학진단.
Objective To study the present situation of misdiagnosed acute pancreatitis(AP)in China and to im prove the identification of AP.Methods One hundred and forty.four documents of Chinese-language cases studies involving the misdiagnosis of AP published from 1988 to 2007 were identified by searching in the China National Knowledge Infrastructure(CNKI).Retrospective study of misdiagnosed diseases,clinical manifestations,risk fac tors and accessory examinations etc,Was made in 1098 patients with AP.Results(1)The patients related to the departments of internal medicine,surgery,obstetrics and gynecology,and pediatrics and so on.The misdiagnosed diseases were over 63 kinds.The first five places successively were:cholelithiasis combined with biliary infection (182 times),acute gastroenteritis(158 times),coronary heart disease(108 times),acute appendicitis(102 times),and intestinal obstruction(90 times).(2)Abdominal pain(878 cases)is the main manifestation in AP, and the first five regions of abdominal pain successively were:upper-middle abdomen(434 cases),whole abdomen (220 cases),right lower quadrant(79 cases),right upper quadrant(74 cases),left upper quadrant(71 cases). (3)Cholecystolithiasis(145 cases)was the first risk factor,and followed the order of fat meal(106 cases)＞chronic cholecystitis(72 eases)＞alcohol(67 times).(4)The number of cases diagnosed by operation was the most,up to 378;others successively were serum and urine amylase examinations(35 1 CtLSe8)and abdominal CT scan(135 cases),and abdominal ultrasound imaging(59 cases).Conclusions(1)The main causes of misdiag nasis were superficial understanding of predisposing condition,lack of correct analysis on clinical manifestations, and mistakes in the analysis Oil the accessory examinations.(2)Although amylase in serum or urine has limitation in diagnosis,it still Was the main method of diagnosis;and it Was necessary to be examined by abdominal CT or sur gical exploration for patients who were highly suspected as having AP but could not be diagnosed.