腹主动脉瘤破裂的误诊误治

腹主动脉瘤的主要威胁是突发破裂，病情危重，病死率极高。腹痛、休克、腰背痛、腹部博动性肿块是腹主动脉瘤破裂最常见的表现，螺旋CT、彩超是主要辅助检查手段。腹主动脉瘤破裂症状富于变化，极易引起误诊，误诊疾病包括肾绞痛、胃肠道出血及破裂、肠梗阻、乙状结肠憩室炎、胆囊炎、胰腺炎、嵌顿性腹股沟疝、心肌梗死、腹部钝性外伤等。误诊的主要原因是临床医生对该病不熟悉，思维局限。救治办法是紧急开腹手术切除或行腔内治疗。误诊患者的病死率明显增高，不恰当的辅助检查和术前准备均造成手术延误，错误的手术止血方式也可能导致灾难性的后果。

Misdiagnosis and mistherapy of ruptured abdominal aortic Aneurysms

Rupture of abdominal aortic aneurysm(RAAA)is a catastrophic complication of AAA with a high mortality.The most common initial physical findings are abdominal pain,back pain,shock and pulsatile abdominal mass.Ultrasound and spiral CT are sensitive in identifying the presence of RAAA and in common use.Confusing symptoms often lead to a variety of misdiagnosis in RAAA,such as renal colic,gastrointestinal hemorrhage or perforation,bowel obstruction,sigmoid diverticulitis,acute cholecystitis,acute pancreatitis,incarcerated inguinal hermia,acute myocardial infarction and abdominal blunt trauma.The mortality in misdiagnosed RAAA is significantly higher than that in correctly diagnosed RAAA.Early emergent surgical repair or endovascular graft exclusion is therapeutic method for RAAA,but its benefit can be lowered due to misdiagnosis,poor operational skill and delay in the CT scanning or unreasonable preparation for surgery.