结肠癌误诊为阑尾炎的临床分析

目的 探讨结肠癌被误诊为阑尾炎的原因及相应的预防对策.方法 回顾性分析2006年1月至2012年1月收治的被误诊为阑尾炎的15例结肠癌病例的临床资料.结果 15例结肠癌术前6例误诊为急性阑尾炎,6例误诊为慢性阑尾炎,3例误诊为阑尾周围脓肿.结肠癌确诊时间：术中8例、术后4例、术后延迟确诊3例,分别于术后1、3、4个月确诊.病理诊断明确后行一期右半结肠切除术8例,二期右半结肠切除术6例,二期右半结肠切除＋横结肠切除术1例.结论 以急性阑尾炎表现为首发症状的结肠癌鉴别诊断困难,术前、术中甚至术后均有可能出现误诊和漏诊.避免误诊、漏诊的首要措施是详细收集病史、仔细体格检查、做好鉴别诊断及术前相关辅助检查.对阑尾炎症状不典型或年龄超过45岁的患者,应按结肠癌的诊疗指南来执行,重视术前、术中和术后异常情况的追踪,警惕结肠癌的可能.

Clinical analyses of colon carcinoma misdiagnosed as appendicitis

Objective To explore the causes and preventive measures of colon cancer misdiag- nosed as appendicitis. Methods Retrospective analyses were performed for the clinical data for 15 ca- ses of colon cancer patients misdiagnosed as appendicitis during January 2006 to January 2012 at our department. Results Among them, the misdiagnoses were acute appendicitis （n = 6）, chronic appen- dicitis （n = 6） and appendicular abscess （n = 3）. The definite diagnosis of colon cancer was made intra- operatively （n = 8）, post-operatively （n = 4） and delayed until 1, 3 ＆ 4 months （n = 3）. The proce- dures included primary right hemicolectomy （n = 8）, secondary right hemicolectomy （n = 6） and sec- ondary right hemicolectomy plus colon resection （n = 1）. Conclusions The differential diagnoses are difficult for colon cancer with presenting symptoms of acute appendicitis. Its wrong and missed diag- nosis is common pre-operatively. The primary preventive measures are detailed history taking, careful physical checkup and relevant auxiliary examinations. For patients aged over 45 years with atypical ap- pendicitis symptoms, the guidelines for the diagnosis and treatment of colon cancer should be followed to watch closely for intra-operative abnormalities and guard against colon cancer.