右半结肠癌95例误诊与漏诊分析

目的：总结右半结肠癌误诊和漏诊的原因，探讨对策。方法：回顾性分析95例被误诊和漏诊的右半结肠癌患者的临床资料。结果和结论：95例中主要表现为右腹痛和包块者48例，解黑便和潜血试验阳性者11例，腹痛、烂便或腹泻者27例，只有大便性状改变者2例，首发贫血者7例。误诊为慢性阑尾炎和阑尾脓肿18例，消化性溃疡15例，十二指肠球部溃疡出血4例，慢性胃炎6例，慢性胆囊炎15例，慢性结肠炎12例，缺铁性贫血7例，结肠克罗恩病2例，肠结核4例，肠易激综合征2例，钩虫病1例，阿米巴痢疾1例，中医漏诊右半结肠癌8例。误诊和漏诊原因：主诊医生对黑便、粪潜血试验阳性、我国青年大肠癌的特点和缺铁性贫血的病因认识不足，片面强调了X线钡剂灌肠造影的结果；部分专科医生结肠镜的操作技术较差。只要采取反复多次行粪潜血试验和全结肠镜检查等措施，则可以减少或避免右半结肠癌的误诊和漏诊。

Analysis of misdiagnosis and miss - diagnosis of right side colon cancer in 95 cases

Objective: To analyze the causes of misdiagnosis and miss diagnosis of right side colon cancer,in order to reduce or avoid the same mistakes. Methods: Clinical data of 95 patients with right side colon cancer were analyzed retrospectively. Results and Conclusions: In 95 cases with right side colon cancer,there were 48 cases with right abdominal pain and lump,11 cases with melena and positive occult blood test,27 cases with abdominal pain and sodden feces or diarrhea,only 2 cases with changes in stool properties,7 cases with the first sign of anemia. 18 cases were misdiagnosed as chronic appendicitis or appendicular abscess,15 cases as peptic ulcer,4 cases as hemorrhage of duodenal ulcer,6 cases as chronic gastritis,15 cases as chronic cholecystitis,12 cases as chronic colitis,7 cases as iron deficiency anemia,2 cases as Crohn's disease in colon,4 cases as intestinal tuberculosis,2 cases as irritable bowel syndrome,1 case as ancylostomiasis. 1 case was intestinal amebic dysentery,and 8 cases with right side colon cancer were miss-diagnosed in chinese medicine clinic. The causes of the misdiagnosis and miss-diagnosis were mainly poorly understanding the origins of melena or the importance of positive occult blood test,the features of the young with large intestinal cancer in our country,the etiology of iron deficiency anemia,special signs of right side colon cancer,non-skilled colonoscopy and overemphasize the result of barium enema. Repeated fecal occult blood tests and colonoscopy,examinations can help reduce or avoid the misdiagnosis and miss-diagnosis of right colon cancer.