腹腔脏器病变术前经腹超声检查漏诊及误诊原因

  目的  评估腹腔脏器病变患者术前经腹超声检查报告并分析超声漏诊及误诊的原因。  方法  通过病理工作站导出2013年3月1日至8月31日因腹腔脏器(肝脏、胆囊、胆管、胰腺、脾脏、肾脏、肾上腺和阑尾)病变于北京协和医院进行手术治疗的住院患者病理资料, 评估相应超声报告, 记录漏、误诊报告信息, 分析漏、误诊原因。  结果  共评估超声报告1081份, 漏、误诊报告58份(5.37%, 58/1081), 其中肝脏病变6例(5.77%, 6/104), 均为误诊; 胆囊和胆管病变6例(1.30%, 6/462), 漏诊5例、误诊1例; 胰腺病变14例(19.72%, 14/71), 均为漏诊; 肾脏和肾上腺病变20例(6.47%, 20/309), 漏诊11例、误诊9例; 阑尾病变12例(16.00%, 12/75), 漏诊11例、误诊1例。漏诊结节样病变最大径平均值显著低于误诊病变(P=0.001)。  结论  不同腹腔脏器病变因性质、部位、体积以及超声本身的局限性等原因导致超声漏诊或误诊, 超声医师在临床工作中应做到全面、仔细、谨慎, 了解各腹腔脏器病变的自身特点以及超声显像的局限性, 不断积累经验, 尽可能避免不必要的错误。

Causes of Missed Diagnosis and Misdiagnosis of Abdominal Organ Lesions in Preoperative Transabdominal Ultrasound

  Objective  To analyze the causes of missed diagnosis and misdiagnosis of abdominal organ lesions through reviewing preoperative transabdominal ultrasound reports.  Methods  Data of the patients who received abdominal operation for abdominal organ lesions (including liver, gallbladder, biliary tract, pancreas, spleen, kidney, adrenal gland, and appendix) in Peking Union Medical College Hospital within the period from March 1 to August 31 in 2013 were exported from pathological workstation. The preoperative ultrasound reports of these patients were reviewed. The missed diagnosis and misdiagnosis cases were recorded, and causes of the mistakes were analyzed.  Results  Altogether 58 cases of missed diagnosis or misdiagnosis were identified from 1081 ultrasound reports (5.37%, 58/1081), including 6 liver lesions (5.77%, 6/104, all misdiagnosed), 6 gall-bladder and biliary tract lesions (1.30%, 6/462, 5 missed and 1 misdiagnosed), 14 pancreatic lesions (19.72%, 14/71, all missed), 20 kidney and adrenal lesions (6.47%, 20/309, 11 missed and 9 misdiagnosed), and 12 appendical lesions (16.00%, 12/75, 11 missed and 1 misdiagnosed). The average maximum diameter of the missed nodular lesions was significantly smaller than that of the misdiagnosed lesions (P=0.001).  Conclusions  Missed diagnosis and misdiagnosis of ultrasound are attributable to various causes, including the nature, location, and size of abdominal organ lesions and the limitation of transabdominal ultrasound technology. The clinical ultrasound examination should be carried out very carefully and thoroughly. Ultrasound radiologists should have a thorough understanding of characteristics of different organ lesions and the limitation of ultrasound technique, in order to avoid missed diagnosis and misdiagnosis in clinical practice.