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目的:探讨急性阑尾炎误诊原因和预防措施。方法:回顾性分析我院在2005年1月至2012年12月期间施行的1 826例阑尾切除病例资料。结果:发现58例其他疾病被误诊为急性阑尾炎而误手术,总误诊率为3.18%。术中即刻明确为误诊的共51例,术后才明确为误诊的共7例。结论:误诊原因分三大类:(1)疾病本身的因素,如阑尾位置变异、异位;(2)医生的因素,多数是由于病史采集不全面、体格检查不全面、不细致、临床经验不足所致;(3)患者的因素;(4)过于依赖模棱两可的辅助检查结果如彩超。预防误诊的主要措施包括:(1)详细的病史采集、全面细致的体检和相关的辅助检查,同时尽可能让辅助检查与临床表现一致;(2)加强专业知识的学习,提高临床诊疗水平;(3)对于孕妇、老年人、小儿临床不典型者,应注意动态观察病情变化,必要时请专科医师会诊,以免漏诊或误诊;(4)抓好术前再诊断和手术适应证。
Objective: To investigate the causes and preventive measures of misdiagnosis of acute appendicitis. Methods: A retrospective analysis of 1 826 cases of appendectomy in our hospital from January 2005 to December 2012 was performed. Results: 58 cases of other diseases were misdiagnosed as acute appendicitis and misdiagnosed, the total misdiagnosis rate was 3.18%. Immediately clear intraoperative misdiagnosis of a total of 51 cases, after surgery was clearly misdiagnosed a total of 7 cases. Conclusion: The causes of misdiagnosis are divided into three categories: (1) the factors of the disease itself, such as the location of the appendix variation, ectopic; (2) the doctor’s factors, mostly due to incomplete medical history, physical examination is not comprehensive, not detailed, clinical experience Insufficient; (3) the patient’s factors; (4) over-reliance on ambiguous auxiliary test results such as ultrasound. The main measures to prevent misdiagnosis include: (1) detailed history collection, comprehensive and detailed physical examination and related auxiliary examination, and as far as possible to make auxiliary examination consistent with clinical manifestations; (2) to strengthen the study of professional knowledge and improve the clinical diagnosis and treatment; (3) For pregnant women, the elderly, pediatric patients with atypia, should pay attention to dynamic observation of changes in condition, if necessary, consult a specialist physician to avoid misdiagnosis or misdiagnosis; (4) grasp the preoperative diagnosis and surgical indications.