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目的分析小儿阑尾炎误诊原因,降低小儿阑尾炎的误诊率。方法回顾2002年10月至2009年3月首诊误诊的26例急性阑尾炎的临床资料,对病史、相关检查结果、手术所见进行回顾性研究,分析误诊原因。结果术前诊断为其他疾病,手术确诊为阑尾炎22例;术前诊断为阑尾炎,手术证实为其他疾病4例。结论对小儿急性阑尾炎的临床症状特点缺乏足够的认识,腹部体征的掌握不准确及过多依赖辅助检查是误诊的主要原因。小儿不会准确地表述临床症状,小儿神经系统发育不健全,早期即出现发热、胃肠道症状,多以发热、呕吐为首发症状就诊故易延诊、误诊,年龄越小越突出。耐心细致,反复检查右下腹有无压痛,对诊断有决定性的意义。阑尾炎确诊后应及早手术治疗,对酷似阑尾炎的病例,应当允许阑尾炎误切的存在,但应注意诊断和鉴别诊断,尽量减少误切。
Objective To analyze the causes of misdiagnosis in children with appendicitis and reduce the misdiagnosis rate of appendicitis in children. Methods The clinical data of 26 patients with first diagnosis of acute appendicitis who were misdiagnosed from October 2002 to March 2009 were retrospectively reviewed, and the causes of misdiagnosis were analyzed retrospectively. Results Preoperative diagnosis of other diseases, surgical diagnosis of appendicitis in 22 cases; preoperative diagnosis of appendicitis, confirmed by surgery in 4 cases of other diseases. Conclusions The lack of adequate understanding of the clinical features of acute appendicitis in children, inaccurate mastery of abdominal signs and excessive dependence on laboratory examinations are the main causes of misdiagnosis. Pediatric does not accurately describe the clinical symptoms, pediatric nervous system dysplasia, early that fever, gastrointestinal symptoms, and more to fever, vomiting as the first symptom treatment is easy to referral, misdiagnosis, the younger the more prominent. Patience and meticulous, repeatedly check the right lower abdomen with or without tenderness, the diagnosis of a decisive significance. Appendicitis diagnosis should be as soon as possible after surgery, the resembles appendicitis cases, should allow the existence of false positives appendicitis, but should pay attention to diagnosis and differential diagnosis, to minimize false positives.