胃底疾病误诊为左肾上腺疾病的二例报告并文献复习

Gastric fundus mass misdiagnosed as left adrenal disease:a report of 2 cases and literature review

目的分析我科近年来误将胃底疾病诊断为左肾上腺疾病的2例患者的临床资料和影像学资料,结合文献报道分析误诊原因,降低误诊率,提高诊断准确性。方法通过分析我科将1例胃底憩室误诊为左肾上腺囊肿和1例胃间质瘤误诊为左肾上腺肿瘤患者的临床资料特别是影像学资料进行回顾性分析,并结合文献报道分析疾病的特点。结果误诊为左肾上腺囊肿和肿瘤的胃底憩室和胃间质瘤患者临床表现无特异性,特别是实体肿瘤的患者合并高血压病,易引起误诊;术前应特别重视患者的影像学资料,影像学资料可提供重要参考信息。结论胃底疾病如胃憩室、胃间质瘤等虽发病率较低,临床表现不典型,诊断左侧肾上腺占位病变时当影像学读片发现肿瘤位置偏高,与胃壁粘连等,应高度怀疑胃底疾病,应该进一步行胃镜和上消化道造影等检查,对术前怀疑为胃底疾病的肾上腺区占位,经腹腔行腹腔镜手术能够从容处理胃底疾病,避免后腹膜途径术中需改变手术体位和路径。

Objective To analyze the clinical and imaging data of 2 cases of gastric fundus disease misdiagnosed as left adrenal disease in our department in recent years,and analyze the causes of misdiagnosis combined with literature reports,so as to reduce the misdiagnosis rate and improve the diagnostic accuracy.Methods The clinical data,especially the imaging data of 1 case of gastric fundus diverticulum misdiagnosed as left adrenal cyst and 1 case of gastric stromal tumor misdiagnosed as left adrenal tumor were analyzed retrospectively.Results The clinical manifestations of patients with gastric fundus diverticulum and gastric stromal tumor misdiagnosed as left adrenal cyst and tumor had no specificity,especially in patients with solid tumor complicated with hypertension,it was easy to cause misdiagnosis.Special attention should be paid to the imaging data of patients before operation,which can provide important reference information.Conclusion Although incidence rate of gastric fundus diseases such as gastric diverticulum and gastric stromal tumor is low,the clinical manifestations are not typical.But the location of tumor is high and the adhesion with gastric wall is found.The diagnosis of gastric fundus diseases should be highly suspected.Gastroscopy and upper gastrointestinal tract examinations should be performed further.Transperitoneal laparoscopic surgery can deal with gastric fundus disease calmly and avoid the need to change the position and route of operation in retroperitoneal approach.