闭合性腹部外伤的首诊误诊因素探讨(附72例病例分析)

Factors of Misdiagnosis in Blunt Abdominal Trauma Analysis of 72 Cases

目的探讨闭合性腹部外伤误诊的原因,提高腹部外伤的诊断和治疗水平。方法对我院1997～2003年收治的857例闭合性腹部外伤病例中72例首诊误诊患者(其中外院转诊64例)进行回顾性分析。结果本组72例患者最后都经剖腹手术确诊,多脏器损伤12例,单一脏器损伤58例,无脏器损伤2例。损伤脏器依次为:小肠(27.6%)、脾(21.8%)、肝(18.4%)、十二指肠(10.3%)、胰腺(5.7%)、大肠(5.7%)等。有8例患者出现术后并发症,发生率11.1%。本组72例患者中假阴性检查结果:查体移动性浊音(8/72 1.1%)、腹腔穿刺(12/57 21.1%)、B 超(6/47 12.7%)、X 光片(16/43 37.2%)、CT 检查(2/1825.0%)及腹腔穿刺假阳性(2/57 3.5%)都直接、间接造成了误诊。结论闭合性腹部外伤的误诊多发生于单一脏器的损伤,首诊医生的忽视,不恰当的辅助检查及其假性结果是造成误诊的原因。

Objective To explore the factors of misdiagnosis in blunt abdominal trauma(BAT),in order to the enhance the lever of diagnosis and treatment of BAT.Methods From 1997 to 2003 year,857 cases of BAT admitted in Nanfang hosptial,72 (72/857) cases of them were misdiagnosed in BAT during admission,64 of them were transferred from other hosptial.Results All of them were attested by lap- arotomy.Multiple verceral trauma(16.7% 12/72) ,single visceral trauma(80.5% 58/72),no visceral tranma(2.7% 2/72).Organs of trauma small intestine(27.6%),spleen (21.8%),liver(18.4%),duodenum(10.3%),pancreas( 5.7% ),large intestine(5.7%),8 of them had intercurrent symptoms after operation (8/72 11.1% ).Among 72 cases of BAT false negative occurred in shifting dulmess(8/ 72 11.1%),abdominal paracentesis(12/57 21.1%),ultrasound examination(6/47 12.7%),X-ray(16/43 30.2%),CT(2/18 25.0%)and false positive of abdominal paracentesis(2/57 3.5%)caused misdiagnosis and missed diagnosis.Conclusion Most of mis- diagnosis in BAT occurred in single visceral trauma.The factors were of doctor's overlooking and inpertinent assistant examination with false negative and false positive.