急性阑尾炎术前漏诊右半结肠癌14例分析

Analysis of 14 cases in which hemi-right colon cancer was missed diagnosed (or erroneously diagnosed) for acute appendicitis before operation

目的 探讨预防或减少急性阑尾炎术前漏诊右半结肠癌的措施及二者并存的术中处理。方法 对我院 1990年 1月～2 0 0 2年 10月收治的 14例急性阑尾炎术前漏诊右半结肠癌的原因及并存机理进行回顾性分析。结果 14例漏诊患者中 ,5例行 期右半结肠切除术 ;3例行 期右半结肠切除、回肠造瘘术 ;2例行 期可疑病灶切除、回肠或盲肠造瘘术 , 期行右半结肠切除术 ;3例行回肠造瘘、腹腔引流术 , 期行右半结肠切除术 ;1例单纯行阑尾切除术 ,漏诊肝曲结肠癌 ,术后并发肠梗阻 ,剖腹控查行 期右半结肠切除、回肠造瘘术。结论 掌握外科基本理论 ,遵循外科基本原则 ,避免惯性思维 ,减少漏诊机会 ,常能够避免急性阑尾炎术前漏诊右半结肠癌导致处理不当而带来的一系列问题。

Objective To investigate the ways to prevent or reduce the missed diagnosts of carcinoma of hemi-right colon before operation of acute appendicitis,as well as the solutions in cases when these two diseases are together.Method 14 cases from Jan,1990 to Oct,2002 were retrospected,these cases were all missed diagnosis of carocinoma of hemi-right colon before operation of acute appendicitis,the reasons why they were missed diagnosed and why sometimes these two diseases were together were analyzed.Results Among these 14 cases,5 cases were treeted with primary hemi-right colectomy,3 cases were treated with primary hemi-right colectomy and fistulation in the caecum,2 cases were removed of suspieious focus,fistulation in the caecum or 11eum,secondary heml-right colectomy,3 cases were treated with fistulation in the fleum and cellac drainage,1 case were simply treated with appendectomy and carcinoma in the ritght colle fiexure was missed diagnosed,ileus occurred after operation,exploratory laparotomy were carried out and then primary hemi-right colectomy and fistulation in the ileum were done.Conclusions There and many rules we have to obey,such as to master the basic theory,to obey the principles of surgery,and to avoid empiricism so as to reduce missed diagnosis of carcinome of hemi-right colon before operation of acute appendicitis.