CAJ | 학술논문

目的总结分析眼科临床出现的误诊和漏诊病例的原因,应重视影像学检查,弥补临床常规检查诊断的不足.方法对2007年至2008年两年间门诊和住院病人通过各种影像学检查纠正诊断的37例患者进行分析,年龄6～75岁,男性17例,女性20例.结果在37例患者中,有8例为颈动脉海绵窦瘘(2例外伤性,6例自发性)被诊断为结膜炎或巩膜炎;6例外伤性眶壁线性骨折的儿童被诊断为眼肌麻痹或肌肉断裂,给予保守治疗10至20d无效;2例淋巴瘤和3例泪腺样囊性癌患者被诊断为眼眶炎性假瘤;2例横纹肌肉瘤诊断为眼眶炎症;2例脉络膜黑色素瘤因延误治疗出现眶内蔓延;2例额窦黏液囊肿和1例下直肌缺如诊断为麻痹性斜视;蝶窦颅底病变和眼内占位各1例诊断为知觉性斜视;视神经脑膜瘤和颅内鞍区蝶窦占位各1例诊断为球后视神经炎;1例泪囊鳞癌诊断为泪囊炎;4例骨内血管瘤患者CT软组织窗扫描考虑为骨瘤;2例外伤眶内异物漏诊.结论通过分析总结可见,颈动脉海绵窦瘘、外伤性眶壁线性骨折、外伤眶内异物等通过病史询问,仔细检查和临床经验辅之以影像学检查可以得到正确诊断;有些病变则应对诊断治疗过程中出现的不同表现和不典型症状,要及时鉴别诊断,进行各种影像学检查,排除其他疾病的存在,避免误诊和漏诊.总之,影像学检查是一种有效和必要的,特别是对眶内和颅内病变的揭示有重要价值,在临床工作中应给予重视.
목적 총결분석안과림상출현적오진화루진병례적원인,응중시영상학검사,미보림상상규검사진단적불족.방법 대2007년지2008년량년간문진화주원병인통과각충영상학검사규정진단적37례환자진행분석,년령6～75세,남성17례,녀성20례.결과 재37례환자중,유8례위경동맥해면두루(2예외상성,6례자발성)피진단위결막염혹공막염;6예외상성광벽선성골절적인동피진단위안기마비혹기육단렬,급여보수치료10지20d무효;2례림파류화3례루선양낭성암환자피진단위안광염성가류;2례횡문기육류진단위안광염증;2례맥락막흑색소류인연오치료출현광내만연;2례액두점액낭종화1례하직기결여진단위마비성사시;접두로저병변화안내점위각1례진단위지각성사시;시신경뇌막류화로내안구접두점위각1례진단위구후시신경염;1례루낭린암진단위루낭염;4례골내혈관류환자CT연조직창소묘고필위골류;2예외상광내이물루진.결론 통과분석총결가견,경동맥해면두루、외상성광벽선성골절、외상광내이물등통과병사순문,자세검사화림상경험보지이영상학검사가이득도정학진단;유사병변칙응대진단치료과정중출현적불동표현화불전형증상,요급시감별진단,진행각충영상학검사,배제기타질병적존재,피면오진화루진.총지,영상학검사시일충유효화필요적,특별시대광내화로내병변적게시유중요개치,재림상공작중응급여중시.
Objective To review and analyze reasons of misdiagnosis and missed diagnosis with the clinical routine eye examination and pay attention to imaging examinations to make up for deficiencies in clinical diagnosis.Methods Thirty-seven outpatients and inpatients of correcting diagnosis by imaging examinations were analyzed retrospectively from 2007 to 2008 at Tianjin Eye Hospital.Among them, 17 were males and 20 female between 6 and 75 years old. Results In 37 patients, 8 cases of carotid-cavernous fistula (2 cases of traumatic, 6 cases of spontaneous) were diagnosed as conjunctivitis or scleritis; 6 cases of traumatic orbital wall linear fracture children were diagnosed with ophthalmoplegia or muscle rupture, conservative treatment for 10 to 20 days was invalid; 2 cases of lymphoma and 3 cases of adenoid cystic carcinoma were diagnosed with orbital inflammatory pseudotumor; 2 cases of orbital rnabdomyosarcoma were diagnosed with inflammation; 2 cases of choroidal melanoma with orbital spread due to delay in treatment; 2 cases of frontal sinus mucous cyst and 1 case of absence of inferior rectus were diagnosed as paralytic strabismus; 1 case of sphenoid sinus skull base lesions and 1 case of intraocular lesion were diagnosed as perceptual strabismus; optic nerve meningioma and 1 case of lesion in intracranial space sellar sphenoid sinus were diagnosed for retrob-ulbar optic neuritis; 1 case of squamous cell carcinoma of lacrimal sac diagnosed as dacryocystitis; 4 cases of vascular tumor in bone were considered for osteoma by CT scan only with soft tissue window; 2 cases of traumatic intraorbital foreign body missed.The special show of color Doppler ultrasound of extraocular extension of choroidal melanoma was based on the pathological features of choroidal melanoma.Therefore, color Doppler ultrasound examination of eyes should be combined with other imaging examination method and analyzed comprehensively, in order to obtain a correct diagnosis and guide clinical treatment. Conclusions Imaging examination method is an effective and accurate method, especially for revealing orbital and intracranial lesions, it has an important value that should be reconstructed in clinical work.