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目的 分析小儿阑尾炎的误诊原因 ,降低小儿阑尾炎的误诊率 ,减少术后并发症的发生。方法 回顾我院外科 1997～ 2 0 0 2年误诊的 2 2 5例急性阑尾炎的临床资料 ,通过对其病史、手术所见 ,实验室及辅助检查结果进行回顾性研究 ,分析误诊原因。结果 术前诊断为其他疾病 ,手术确诊为阑尾炎的 16 3例 ;术前诊断为阑尾炎 ,手术证实为其他疾病的 6 2例。全部病例均经手术治疗 ,术后痊愈出院 ,并发症的发生率为 16 .4 4 %。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的依赖辅助检查是误诊的主要原因。对酷似阑尾炎的病例 ,应当允许阑尾误切的存在 ,但应注意诊断和鉴别诊断 ,尽量减少误切。
Objective To analyze the causes of misdiagnosis of pediatric appendicitis, reduce the misdiagnosis rate of pediatric appendicitis and reduce the incidence of postoperative complications. Methods The clinical data of 225 cases of acute appendicitis misdiagnosed from 1997 to 2002 in our hospital were retrospectively analyzed. The causes of misdiagnosis were analyzed retrospectively by the history, the findings of the surgery, the laboratory and the results of laboratory tests. Results Preoperative diagnosis of other diseases, surgical diagnosis of appendicitis in 163 cases; preoperative diagnosis of appendicitis, surgery confirmed as other diseases, 62 cases. All patients were surgically treated, discharged after surgery, the complication rate was 16.44%. Conclusions The lack of adequate understanding of the clinical features of acute appendicitis in children, the inaccurate mastery of abdominal signs and the excessive dependence on laboratory examinations are the main causes of misdiagnosis. For cases of appendicitis, appendectomy should be allowed, but attention should be paid to diagnosis and differential diagnosis to minimize false positives.