急诊外科急腹症42例临床误诊原因分析及对策

目的:分析42例急诊外科急腹症患者临床误诊的原因及解决对策,提高急腹症的正确诊断率。方法:对2007年3月-2011年3月我院收治的42例急诊外科急腹症误诊患者的临床资料进行回顾性分析。结果:误诊42例患者中溃疡病误诊为急性胆囊炎8例;肠系膜淋巴结炎误诊为急性阑尾炎3例;急性肾炎误诊为尿路结石5例;妇产科疾病误诊为外科急腹症12例(盆腔炎误诊为阑尾炎7例;右侧输卵管脓肿误诊为阑尾炎3例;卵巢囊肿误诊为肠扭转2例);上消化道穿孔误诊为阑尾炎8例;小儿肠套叠误诊为中毒性菌痢2例;嵌顿性疝误诊为急性胃肠炎4例。42例患者全部进行急救处理或抢救治疗,除1例死亡外,全部好转或治愈出院。结论:外科急腹症患者误诊的原因包括:病史询问不详细、查体不仔细、辅助检查不完善、病情进展观察不仔细、手术解剖不清楚、操作鲁莽等。详细询问患者病情,认真仔细查体,密切观察病情变化,分析变化原因并结合必要的辅助检查是减少或避免误诊的关键。

The Analysis of the Misdiagnosis and Countermeasures for 42 Cases in Emergency Surgical Abdomen

Objective:To analyze the misdiagnosis and countermeasures for 42 cases in emergency surgical abdomen to improve the rate of correct diagnosis of the acute abdomen.Methods:The clinical data of 42 cases of emergency surgical abdomen misdiagnosed patients in our hospital from March 2007 to March 2011 was taken for retrospective analysis.Results:In the 42 patients of misdiagnosed patients,the ulcer disease was misdiagnosed as acute cholecystitis was in 8 cases.Mesenteric lymphadenitis was misdiagnosed as acute appendicitis was in 3 cases.The acute nephritis was misdiagnosed as urinary tract stone was in five cases.The obstetrics and gynecology was misdiagnosed as acute abdomen was in 12 cases(pelvic inflammatory disease misdiagnosed as appendicitis 7 cases;the right tubal abscess misdiagnosed appendicitis 3 cases;ovarian cyst misdiagnosed as volvulus 2 cases).The gastrointestinal perforation was misdiagnosed as appendicitis was in eight cases.The intussusception in children was misdiagnosed as toxic bacillary dysentery was in 2 cases.The incarcerated hernia was misdiagnosed as acute gastroenteritis was in four cases.All 42 patients were taken with first aid treatment or salvage therapy,in addition to the deaths,all improved or cured.Conclusion:The surgical abdomen patients misdiagnosed reasons include:not detailed history taking,not careful physical examination,imperfect auxiliary examination,not carefully observation of the progress of the disease,surgical anatomy unclear operation reckless.Asked in detail about the patient's condition,carefully examination,close observation of changes in conditions,analysis of the reasons for the changes,combined with the necessary laboratory examinations are the key to reduce or avoid misdiagnosis.