布加综合征460例误诊误治原因探讨

目的探讨布加综合征（ＢＣＳ）的误诊误治情况及其原因，以及避免误诊误治的方法。方法对就诊的５２０例ＢＣＳ病人的诊断和治疗情况进行调查和统计分析，了解误诊误治情况及易误诊的疾病。结果首次就诊的误诊率为８８５％（４６０／５２０），所误诊的疾病依次为肝硬变、肝炎、大隐静脉曲张等。县区级医院的误诊率为９７５％、地市级医院的误诊率为８１１％、省级以上医院的误诊率为５００％。施行错误治疗有：大隐静脉高位结扎、脾切除、精索静脉结扎等手术，化疗、抗痨治疗及其他药物治疗。结论ＢＣＳ的误诊率较高，且常被误治。避免误诊的方法有：（１）注意寻找本病的特征性表现；（２）合理应用影像学检查如Ｂ型超声、下腔静脉造影等。

Diagnosis and treatment errors of Budd Chiari syndrome in 460 cases

Objective To investigate causes of misdiagnosis and resultant treatment in error in patients suffering from Budd Chiari syndrome (BCS) and evaluate ways of avoiding the misdiagnosis. Methods The case history of 520 patients with BCS admitted from 1987 to 1996 was retrospectively analyzed and misdiagnostic rate was calculated against the final diagnosis.Results The misdiagnosis rate for the first time the patients sought for medical advice was 88 5% (460/520).Patients were often misdiagnosed as liver cirrhosis, hepatitis, vavicosis of great saphenous vein, etc. The misdiagnosis rate at community hospitals was 97 5%,at municipal hospitals 81 1%,and at provincial hospitals and hospitals affiliated to medical colleges 50%. Treatment errors led by misdiagnosis included operative measures (high ligation of great saphenous vein, splenectomy, high ligation of internal spermatic cord vein, etc),antineoplastic chemotherapy, antituberculotic therapy and other pharmaceutical therapy according to diseases misdiagnosed.Conclusions Measures that are effective to avoid misdiagnosis include:(1) to look for specific manifestations of BCS and comprehensive study of the case history.(2) to use image examination such as B mode ultrasonography and phlebography of inferior vena cava to the patients with specific manifestations of BCS.