误诊为恶性疾病行胰十二指肠切除术10例分析

ANALYSIS OF 10 MISDIAGNOSED CASES FOR PAN CREATODUODENECTOMY

１９８１～１９９４年间我院外科共作胰头十二指肠切除术４５例，其中术后确诊为胰头癌及壶腹部癌仅３５例，其余１０例为：慢性胰腺炎３例，胆总管下端结石梗阻２例，十二指肠胰腺异位２例，胆总管远端炎性狭窄１例，Ｏｄｄｉ’ｓ括约肌腺肌病和十二指肠降部胼胝性溃疡各１例。通过该１０例的误诊分析，作者强调：①术前详细询问病史，对黄疸的发展规律及其伴随症状要作仔细分析鉴别；②全面收集临床资料，科学地对待和正确合理地选择影像学检查，避免单凭某一项检查结果作为临床诊断之唯一依据；③术中应逐步全面细致作胰头壶腹区探查，对可疑病变应作局部细针穿刺活检，务使诊断明确后选择手术方式，力争避免和降低误诊率。

Forty-five pancreatoduodenectomies had been performed in our hospital from 1981 to 1994, of which 35 cases were diagnosed as carcinomas of Vater' s ampulla or pancreatic head,and 10 (cases) as benign lesions. Through analysis of misdiagnosed cases,the authors emphasize that it is important to take correct history of jaundiced patients in detail according to the character of the jaundice and associated symptoms before any operation done. Secondly,all clinical materials must be thoroughly collected and special examinations for diagnosis should be chosen scientifically to avoid relying only on one sort of examination result as diagnostic standard. Thirdly,during operation the area of pancreatic head should be explored carefully and any lesions in doubt should be examined pathologically by puncture biopsy and frozen section to avoid misdiagnosis and thus performing pancreatoduodenectomy.