延迟性脾破裂误漏诊原因分析

Analysis of misdiagnosis of delayed rupture of spLeen

目的 探讨延迟性脾破裂误漏诊原因和预防措施。方法 回顾性分析总结１２例延迟性脾破裂中的诊断和误漏诊的经验与教训。结果 本组延迟性脾破裂的误漏诊５例（４１．６６％）。对多发伤与脾破裂并存可能认识不足，外伤史轻微或伤员隐瞒外伤史，缺乏腹痛－缓解－突然再腹痛的典型病史，缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因。结论 详细的外伤史和全面系统检查，重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能。确立外伤－腹内脏器伤－脾破裂整体化诊断思路。不间断地辅以Ｂ超检查脾形态学变化和腹内有无积液，腹腔穿刺确定有无血腹、Ｘ线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时ＣＴ检查以尽早发现脾包膜下血肿，降低延迟性脾破裂误漏诊率。

Objective To analyse the cause of misdiagnosis of delayed rupture of spleen(DRS) and find precautiona ry measu res to prevent it.Methods Experience in diagnosis of 12 cases w as reviewed.Results The rate of mistaken diagnosis in this grou p was 41.66%(5/12).The main cause of mistaken diagnosis were:multiple wounds co existing with fupture of spleen,slight injury or hiding history of injury on the side of patients,lack of typical history of abdominal pain-relief-sudden recurrence of abdominal pain,lack of mechanics analysis of corresponding rupture of spleen and overall idea of diagnosis.Conclusion It is possible to reduce the rate of mistaken diagnosis of DRS by detailed history of injury,complete physical examination,paying more attention to multiple wounds outside and inside abdomen,establishing the overall idea of diagnosis,ultrasonographic B examination repeatedly to follow the morphological changes of spleen and fluid accumulated in the abdominal cavity,abdominal centesis to establish the presence of blood inside abdomen,radiograph to observe the movement of left costophrenic phrenic angle and that of the diaphragm.CT scan is very useful in detection of hematoma under capsule of the spleen.