胆囊腺肌瘤病超声漏诊和误诊原因分析

目的:根据胆囊腺肌瘤病(gallbladder adenomyoma,GBA)超声诊断与病理对照情况,分析超声诊断GBA漏诊及误诊的相关因素。方法:回顾性收集2010年1月至2018年11月解放军总医院426例术后病理诊断为GBA且术前病历完整的患者信息,分析其术前超声诊断、临床症状、病理分型等因素,计算超声诊断GBA符合率、漏诊率,根据多因素及单因素Logistic回归,分析超声诊断GBA的漏诊及误诊影响因素。结果:本组病例超声诊断符合率为46.9%(200/426),漏诊率为35.2%(150/426),误诊率为17.8%(76/426)。将GBA误诊为胆囊占位65例(85.5%,65/76),胆囊结石7例(9.2%,7/76),慢性胆囊炎4例(5.3%,4/76)。多因素Logistics回归分析结果显示合并胆囊结石(OR=5.112,P<0.001)、慢性胆囊炎(OR=4.613,P<0.001)、胆囊占位(OR=6.565,P<0.001)以及胆固醇结晶(OR=8.634,P<0.001)是超声正确诊断GBA的独立影响因素。结论:目前超声对GBA具有较高漏诊及误诊率,需要超声医生完整扫查胆囊切面;大部分病例合并其他胆囊疾病,故超声检查胆囊不能只满足于单一疾病的诊断。

Analysis of the causes of misdiagnosis of gallbladder adenomyoma by ultrasound

Objective To analyze the factors of missed diagnosis and misdiagnosis of gallbladder adenomyomatosis(GBA)by ultrasonography according to the contrast between ultrasonography and pathology.Methods Four hundred and forty-six cases of patients with pathological diagnosis of GBA and complete preoperative case informations were retrospectively collected from January 2010 to November 2018 in the PLA General Hospital,and the preoperative ultrasound diagnosis,clinical symptoms,pathological classification were analyzed.The coincidence rate and missed diagnosis rate of GBA by ultrasound were calculated.The ultrasonic diagnosis of GBA missed diagnosis and misdiagnosis factors were analyzed according to the multiple factors and single factor Logistic regression.Results The coincidence rate of ultrasonic diagnosis was 46.9%(200/426),the missed diagnosis rate was 35.2%(150/426),and the misdiagnosis rate was 17.8%(76/426).Misdiagnosed cases included 65 cases(85.5%)of gallbladder occupation,7 cases(9.2%)of gallbladder stones,and 4 cases(5.3%)of chronic cholecystitis.The results of multi-fact OR Logistics regression analysis showed that gallbladder stones(OR=5.112,P<0.001),chronic cholecystitis(OR=4.613,P<0.001),gallbladder occupation(OR=6.565,P<0.001)and cholesterol crystals(OR=8.634,P<0.001)were independent influencing factors for accurate diagnosis of GBA by ultrasound.Conclusions Ultrasound has a high rate of missed diagnosis and misdiagnosis for GBA operation group at present.Since most cases are complicated with other gallbladder diseases,it is important to scan carefully for GBA besides the diagnosis of a single gallbladder disease.