实用骨科杂志
實用骨科雜誌
실용골과잡지
Journal of Practical Orthopaedics
2015年
11期
971-974,1014
,共5页
腰椎%转移瘤%腰椎间盘突出症%误诊
腰椎%轉移瘤%腰椎間盤突齣癥%誤診
요추%전이류%요추간반돌출증%오진
lumbar%metastatic tumor%lumbar disc herniation%misdiagnosis
目的：探讨腰椎转移瘤误诊为腰椎间盘突出症的临床误诊原因，以提高临床诊疗水平，降低误诊率。方法对我院自2008年10月至2014年12月共32例首诊以腰椎间盘突出症收住入院，最终确诊为腰椎转移肿瘤且能有效回访的患者进行回顾性研究，分析其误诊原因。结果本组患者均以腰腿痛为首发症状，原发灶来源分别为：肺癌11例、乳腺癌6例、肝癌4例、胰腺癌3例、食管癌2例、胃癌1例、甲状腺癌1例、前列腺癌1例，3例未发现原发灶。3例未发现原发灶患者：1例经病理检查提示腺癌，来源不明，未找到原发灶；1例病理检查提示腺癌，经免疫组化确诊为转移性肺中低分化腺癌，未找到原发灶；1例来源不明，未找到原发灶。结论腰椎间盘突出症的诊疗过程中若发现有腰腿痛患者经保守治疗效果欠佳，应避免过分依赖腰椎 CT，需全面收集临床资料，仔细查体，详细询问病史，综合分析，对腰椎转移瘤保持高度警惕以免误诊。
目的：探討腰椎轉移瘤誤診為腰椎間盤突齣癥的臨床誤診原因，以提高臨床診療水平，降低誤診率。方法對我院自2008年10月至2014年12月共32例首診以腰椎間盤突齣癥收住入院，最終確診為腰椎轉移腫瘤且能有效迴訪的患者進行迴顧性研究，分析其誤診原因。結果本組患者均以腰腿痛為首髮癥狀，原髮竈來源分彆為：肺癌11例、乳腺癌6例、肝癌4例、胰腺癌3例、食管癌2例、胃癌1例、甲狀腺癌1例、前列腺癌1例，3例未髮現原髮竈。3例未髮現原髮竈患者：1例經病理檢查提示腺癌，來源不明，未找到原髮竈；1例病理檢查提示腺癌，經免疫組化確診為轉移性肺中低分化腺癌，未找到原髮竈；1例來源不明，未找到原髮竈。結論腰椎間盤突齣癥的診療過程中若髮現有腰腿痛患者經保守治療效果欠佳，應避免過分依賴腰椎 CT，需全麵收集臨床資料，仔細查體，詳細詢問病史，綜閤分析，對腰椎轉移瘤保持高度警惕以免誤診。
목적：탐토요추전이류오진위요추간반돌출증적림상오진원인，이제고림상진료수평，강저오진솔。방법대아원자2008년10월지2014년12월공32례수진이요추간반돌출증수주입원，최종학진위요추전이종류차능유효회방적환자진행회고성연구，분석기오진원인。결과본조환자균이요퇴통위수발증상，원발조래원분별위：폐암11례、유선암6례、간암4례、이선암3례、식관암2례、위암1례、갑상선암1례、전렬선암1례，3례미발현원발조。3례미발현원발조환자：1례경병리검사제시선암，래원불명，미조도원발조；1례병리검사제시선암，경면역조화학진위전이성폐중저분화선암，미조도원발조；1례래원불명，미조도원발조。결론요추간반돌출증적진료과정중약발현유요퇴통환자경보수치료효과흠가，응피면과분의뢰요추 CT，수전면수집림상자료，자세사체，상세순문병사，종합분석，대요추전이류보지고도경척이면오진。
Objective To explore the reason why patients of Lumbar metastic tumor was misdiagnosed as syndrome of lumbar disc herniation,and improve the level of clinical treatment and reduce the rate of misdiagnosed. Methods This re-search enrolled 32 patients in standard between October 2008 and December 2014 in our hospital,who were diagnosed as syn-drome of lumbar disc Herniation at their initital diagnosis and as Lumbar metastic tumor at their final diagnosis. It was a retro-spective study of effective visit from the patients. Results Lumbocrural pain were the primory symptom for all cases. There were 11 cases of lung cancer,6 cases of breast cancer,4 cases of liver cancer,3 cases of pancreatic cancer,2 cases of esopha-geal cancer,1 cases of gastric cancer,1 cases of thyroid cancer,1 cases of prostate cancer. 3 cases had found no primary foci:1 cases of adenocarcinoma by pathological examination,1 cases eventually was identified as low differentiation adenocarcinoma of the lung adenoca by immunohistochemical and 1 case of unknown primary site. Conclusion In the diagnosis of lumbar Disc Herniation,if there was poor efficacy to reduce umbocrural pain by conservative treatment,necessary of clinic information col-lection,careful checking,comprehensive analysis and possibility of Lumbar metastatic tumor should be considered.
