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我院1988—1998年共收治结肠癌115例,其中并发急性阑尾炎16例,占同期结肠癌的13.9％。现就延误结肠癌诊治的原因以及减少漏误诊的措施进行讨论,报道如下。1 临床资料1.1 一般资料 男13例,女3例,年龄23～86岁,平均50岁,其中40岁以上12例（75％）。结肠癌部位:盲肠7例,外结肠4例,肝曲3例,乙状结肠2例。右半结肠癌合并急性阑尾炎占17.5％（14/80）。临床表现:转移性右下腹痛5例,持续性右下腹痛11例;发热8例;恶心呕吐10例。右下腹压痛16例;右下腹反跳痛14例;肌卫11例,腹泻5例;可明显触及肿块2例,起病至就诊时间为2d～2年;15例白细胞>10×10~9/L,12例N>0.75。本组均经手术,钡灌肠或纤维结肠镜及病理证实,14例以急性阑尾炎急诊行阑尾切除术,7例术中发现结肠癌,7例阑尾切除术后仍反复腹痛和腹部肿块而行钡灌肠造影或纤维结肠镜等检查或再次手术探查,于术后3～8个月内确诊,2例诊为阑尾周围脓肿行姑息治疗无效,经作钡灌肠造影及手术探查而确诊。本组术后均作病理检查:急性化脓
In our hospital from 1988 to 1998, a total of 115 cases of colon cancer were treated, including 16 cases of acute appendicitis, which accounted for 13.9% of the colon cancer in the same period. The reasons for delaying the diagnosis and treatment of colon cancer and the measures to reduce misdiagnosis and misdiagnosis are discussed. The report is as follows. 1 Clinical data 1.1 General information Male 13 cases, female 3 cases, aged 23 to 86 years old, an average of 50 years old, of which more than 40 years old 12 cases (75%). Sites of colon cancer: 7 cases of cecum, 4 cases of external colon, 3 cases of hepatic curvature and 2 cases of sigmoid colon. Right-sided colon cancer with acute appendicitis accounted for 17.5% (14/80). Clinical manifestations: metastatic right lower abdominal pain in 5 cases, persistent right lower abdominal pain in 11 cases; fever in 8 cases; nausea and vomiting in 10 cases. The right lower quadrant tenderness in 16 cases; the right lower quadrant rebound tenderness in 14 cases; muscle guarding in 11 cases, diarrhea in 5 cases; can significantly affect the mass in 2 cases, onset to treatment time is 2d ~ 2 years; 15 cases of white blood cells> 10 10 9 /L, 12 cases N>0.75. All patients underwent surgery, barium enema or colonoscopy and pathology. 14 patients underwent appendicectomy in acute appendicitis, colon cancer was found in 7 patients, and abdominal pain and abdominal mass were repeated after appendectomy in 7 patients. Enema angiography or colonoscopy examination or re-exploration surgery, diagnosed within 3 to 8 months after surgery, 2 cases of peri-appendicular abscess around the palliative treatment was invalid, confirmed by barium enema angiography and surgical exploration. This group was postoperative pathological examination: acute suppuration