老年食管癌误诊分析

目的通过对 60岁以上食管癌患者的误诊情况分析 ,进一步提高老年食管癌的诊断水平与治愈率。方法对我院 1995年9月～ 2 0 0 2年 11月收治的 82例老年食管癌进行回顾性统计和分析 ,找出老年食管癌在门诊及住院诊治过程中产生误诊的主要原因。结果本组共有 3 9例误诊 ,院外误诊 3 0例 ,院内误诊 9例。手术治疗 16例 ;非手术治疗 2 3例 ,2 3例中行食管支架治疗 9例。治愈 10例 ,好转 16例 ,未治 9例 ,自动出院 3例 ,死亡 1例。结论院外误诊主要与患者的素质、门诊医生对老年食管癌特点的认识程度有关 ,误诊的时间较长 ,对治疗效果影响较大 ,约 73 3 %的患者失去手术机会。食管吞钡或食管碘油造影检查是诊断或鉴别诊断老年食管癌最方便、经济、易为患者接受的检查方法。院内误诊主要与患者的发病方式有关 ,误诊时间短 ,对治疗效果影响小。临床遇有进食梗阻感、胸骨后疼痛、剑突下或胸骨后烧灼感、排柏油样便、长期嗜烟酒、长期有不良饮食习惯、短期内突然严重咳嗽和大量咳痰者应高度怀疑食管癌。详细询问病史、充分认识老年食管癌的特点以及规范住院医疗制度 ,是避免老年食管癌误诊的关键

Misdiagnosis of senile esophageal carcinoma

Objective To improve the diagnosis and treatment of senile esophageal carcinoma by analyzing its misdiagnosis in the aged over 60 years.Methods A retrospective study was conducted in 82 cases of senile esophageal carcinoma hospitalized between September, 1995 and November, 2002 in order to find out the causes for misdiagnosis of the tumor at both out-patient and in-patient settings. Results Of the study subjects of the paper, 39 were misdiagnosed with 30 cases at the outside of the hospital and 9 inside; surgical management was undertaken in 16 cases, non-surgical treatment in 23 patients and esophageal stenting underwent in 23 cases. Excellent response was obtained in 10 cases; good response in 16 cases; no treatment was given to 9 cases; 3 cases left the hospital on their own and 1 patient died while hospitalized.Conclusions Misdiagnosis at the outside of the hospital was mainly related with the patients' education and surgeons' knowledge on senile esophageal carcinoma. In this case, the period of misdiagnosis lasted longer and the impact on treatment was worse. About 73.3% of the patients were too late to receive surgery. Barrium and iodized oil radiographies were the simplest, the most economic and the most accepted examinations. Misdiagnosis inside the hospital was principally related with the pathogenic features of the carcinoma. The period of misdiagnosis was shorter and the impact was minor comparatively. In clinical practice, esophageal carcinoma should highly considered when any of the following manifestations was noted: dysphagia, retrosternal pain, upper abdominal or retrosternal burning sensation, tarry stool long-term smoking or alcohol drinking, long-term unhealthy food habit, sudden cough and large amount of expectoration. In this case,they were the key for avoiding misdiagnosis of senile esophageal carcinoma to inquire about a detailed history, to fully understand the characteristics of the carcinoma and to standardize all medical regulations at hospital.