原发性阑尾肿瘤临床误诊原因分析

Analysis of the Misdiagnosis of the Primary Appendiceal Tumor

目的 探讨原发性阑尾肿瘤的误诊原因 ,提高阑尾肿瘤的急诊水平。方法 回顾性分析 2 7例住院手术并经病理确诊为阑尾肿瘤患者的临床资料。结果 2 7例阑尾肿瘤仅 2例术前获确诊。误诊为急性阑尾炎和慢性阑尾炎急性发作 16例 ,误诊为妇科肿瘤 3例 ,肠梗阻 4例 ,消化道出血 2例 ,误诊率 92 .6% ( 2 5 /2 7)。二次手术率为 2 9.6% ( 8/2 7)。病理诊断黏液腺癌 9例 ,类癌 7例 ,腺癌 3例 ,印戒细胞癌 2例 ,腺瘤 6例 (其中 2例发生恶变 )。术中可疑为肿瘤者行快速冷冻切片 ,病理检查确诊为恶性者行右半结肠切除术者 2 2例 ;良性肿瘤和肿瘤直径小于 1cm的类癌行阑尾单纯切除术者 5例。结论 阑尾肿瘤最易误诊为阑尾炎和慢性阑尾炎急性发作 ,对急诊患者应重视阑尾肿块的手术中探查及处理 ;对不能判定性质的肿块 ,术中应常规做冷冻切片行病理检查 。

Objective To discuss the causes of misdiagnosis of primary appendiceal tumor and to improve the emergency diagnosis of the disease.Methods Clinical data of 27 cases with pathologically documented primary appendiceal tumor who underwent surgery treatment were retrospectively analyzed.Results Of the 27 cases,2 cases were diagnosed before operation,seven cases were misdiagnosed as acute appendicitis,9 cases as acute outbreak of chronic appendicitis,3 cases as gynecologic tumors,4 cases as intestinal obstruction and 2 cases as digest tract hemorrhage.The misdiagnosis rate was 92.6%.Eight cases(29.6%) received a second operation.The pathological types of most malignant tumors were mucous adenocarcinoma and carcinoid tumor and the pathological type of most benign tumors was adenoma.Right hemicolectomy was performed in 22 cases who had pathologically documented malignant tumor.Simple appendix resection was performed in 5 cases who had benign tumor or carcinoid tumor(diameter<1 cm).ConclusionAppendiceal tumor was easily misdiagnosed as appendicitis or acute outbreak of chronic appendicitis.The intraoperative exploration and the management of appendiceal mass should be emphasized in the emergency patients.The intraoperative freezing slices is necessary for suspected appendiceal mass to improve the diagnosis accuracy and the therapeutic effect.