CAJ | 학술논문

目的探讨宫腔积脓并子宫穿孔的临床特征以及产生误诊的原因和减少误诊的措施.方法对2008-2013年我院收治的绝经后宫腔积脓并子宫穿孔20例,其中首诊漏、误诊16例患者的临床资料进行回顾性分析,总结其临床特点及误诊的原因以及应该注意的经验教训,以减少对该病的误诊.结果宫腔积脓并子宫穿孔20例,其中首诊漏、误诊16例,发生率80％ (16/20).1例诊断附件瘤蒂扭转;1例诊断盆腔脓肿;14例首诊外科(急性腹膜炎8例、消化道穿孔4例、阑尾炎穿孔2例).均发生于绝经后妇女,主要临床特征:发热、下腹部疼痛、肛门坠胀、盆腔包块、肠鸣音减弱、宫颈举痛.脓液培养阳性率最高是大肠埃希菌.误诊原因主要是临床表现不典型,临床医师缺乏对病情的全面分析和动态观察,过于依靠辅助检查;其急腹症表现常首诊外科,外科医师只重视本科检查,以及对本科疾病诊断的惯性思维,忽视妇科检查.全部病例经过手术治疗一次性治愈.结论宫腔积脓并发子宫穿孔主要发生于绝经妇女,误诊率较高;正确诊断、及时治疗预后较好.
목적 탐토궁강적농병자궁천공적림상특정이급산생오진적원인화감소오진적조시.방법 대2008-2013년아원수치적절경후궁강적농병자궁천공20례,기중수진루、오진16례환자적림상자료진행회고성분석,총결기림상특점급오진적원인이급응해주의적경험교훈,이감소대해병적오진.결과 궁강적농병자궁천공20례,기중수진루、오진16례,발생솔80％ (16/20).1례진단부건류체뉴전;1례진단분강농종;14례수진외과(급성복막염8례、소화도천공4례、란미염천공2례).균발생우절경후부녀,주요림상특정:발열、하복부동통、항문추창、분강포괴、장명음감약、궁경거통.농액배양양성솔최고시대장애희균.오진원인주요시림상표현불전형,림상의사결핍대병정적전면분석화동태관찰,과우의고보조검사;기급복증표현상수진외과,외과의사지중시본과검사,이급대본과질병진단적관성사유,홀시부과검사.전부병례경과수술치료일차성치유.결론 궁강적농병발자궁천공주요발생우절경부녀,오진솔교고;정학진단、급시치료예후교호.
Objective To investigate the clinical features of uterine empyema complicated with perforation of the uterus,the causes of misdiagnosis and measures of reducing misdiagnosis.Methods Twenty clinical cases from 2008 to 2013 in the First People's Hospiptal of Shangqiu were treated postmenopausal,uterine empyema and uterine perforation,and 16 cases of whose first diagnosed leak or misdiagnosed patients were retrospectively analyzed.Summarize the clinical characteristics,misdiagnosis and experiences in order to reduce the misdiagnosis of the disease.Results Among 20 cases of uterine perforation and Uterine empyema,16 cases first diagnosed misdiagnosed,and the incidence was 80％ (16/20).One case was diagnosed tumor torsion,1 case of diagnosis of pelvic abscess,14 cases first diagnosed of surgery (8 cases of acute peritonitis,gastrointestinal perforation in 4 cases and 2 cases of perforated appendicitis).It all occurred in postmenopausal women,and the main clinical features were that:high fever,lower abdominal pain,feel bloated in the rectal,mass pelvic cavity,weakened movement of intestine and cervical disturbance pain.results of emoyemic bacteria culture were mainly colon bacillus (E.coli).The main causes of misdiagnosis were atypical clinical manifestations,clinicians lack of comprehensive analysis and dynamic observation of the disease,over-reliance on laboratory examinations;their performance was often the first diagnosis of acute abdomen surgery,the surgeon only undergraduate examination,as well as undergraduate diagnosis of inertia thinking,neglect gynecological examination.All patients had a one-time cure after surgery.Conclusion Uterine empyema complicated with uterine perforation occurs mainly in postmenopausal women,which had a higher rate of misdiagnosis.Correctly diagnosis and timely treatments make benefits to the prognosis.