美克尔憩室25例临床误诊分析

目的 分析美克尔憩室疾病临床易误诊的主要因素,总结临床诊治经验.方法 复习近10年来我院收治的各类美克尔憩室疾病病例,对比其术前和术后诊断,归纳各类美克尔憩室病临床表现和病理检查的特点.结果 25例均经手术诊断或证实.以腹痛为主要临床表现者术前多诊断为急、慢性阑尾炎或阑尾炎穿孔;憩室致肠梗阻病例则大都考虑为常规性肠套叠、肠扭转或粘连性肠梗阻,未明确主要病因;憩室出血病例误诊为消化性溃疡出血者居多,个别病例误诊为消化道肿瘤.术后病理证实部分为美克尔憩室炎(单纯性或伴坏死穿孔),部分系憩室内迷生组织出血.结论 美克尔憩室大多数无临床症状,多因其并发症而行手术治疗.其特殊的解剖结构导致临床表现复杂,与常见外科疾病易混淆,故术前容易误诊,应引起临床外科医生的重视.

Analysis on Clinical Misdiagnosis of 25 Cases of Meckel Diverticulum

Objective To analysis the important factors which are involved in misdiagnosis of Meckel diverticulum diseases and sum up the clinical experiences of diagnosis and treatment.Methods Different sorts of Meckel diverticulum diseases treated in our hospital in the passed decade were reviewed.A comparison between their diagnosis before operation and after operation was performed and the characteristics of clinical manifestation and pathological examination were discussed.Results The total cases(25) were diagnosed or confirmed in operation.The patients whose principal clinical manifestation was abdominal pain were diagnosed of acute or chronic appendicitis;The patients with intestinal obstructing caused by Meckel diverticulum were diagnosed to be intussusceptions,vovulus or intestinal adhesion,without obtaining their definite etiology;Major part of the patients with diverticulum hemorrhage were misdiagnosed as peptic ulcer hemorrhage and some case was misdiagnosed as peptic tumor hemorrhage.Part of cases were confirmed to be Meckel diverticulum inflammation(simple or necrosis)by pathological examination after operation,the other cases were confirmed to be mysterious tissue in diverticulum.Conclusion Majority of Meckel diverticulum have no clinical symptoms and is operated because of their complications.Their peculiar anatomy structure leads to clinical manifestation complicated,so the disease is easy to confound with common surgery and be misdiagnosed before operation.Surgeon should pay close attention to it.