14例迟发症状儿童先天性膈疝误诊误治分析

Misdiagnosis analysis of 14 children with late-presenting congenital diaphragmatic hernia

目的进一步提高迟发症状儿童先天性膈疝的诊断和治疗水平。方法回顾性分析我科收治的16例迟发症状儿童先天性膈疝的临床资料,并对其中14例误诊的原因进行分析。结果本组16中14例转入我科前误诊误治,其中误诊为急性胃肠炎7例,小儿肺炎3例,先天性膈膨出、先天性肺囊肿、急性脓气胸和气胸各1例,误诊率高达87.5%。14例经X线检查、钡剂或碘油造影、CT、超声检查确诊;15例治愈,1例死亡(死于呼吸衰竭)。结论迟发症状儿童先天性膈疝由于症状迟发且不典型,容易误诊误治。提高对迟发症状儿童先天性膈疝的认识,对疑似病例进行特殊性检查且追踪观察是可望确诊的。

Objective To improve the diagnosis and therapy in children with late-presenting congenital diaphragmmtic hernia （CDH）. Methods Clinical data of 16 children with late-presenting CDH were collected, and misdiagnostic causes were analyzed in 14 cases. Results In 16 cases, 15 cured and 1 died. Of 14 misdiagnosed children, the misdiagmostic causes were acute gastroenteritis （7）, pneumonia （3）, congenital diaphragmatic eventration （ 1 ）, congenital pulmonary cyst （ 1 ）, acute pyopneumoth- orax （1）, and pneumothorax （1）, and the definite diagnosis was made by chest x-ray, barium or iodinaled oil exanination, CT or ultrasonography. Conclusion Late-presenting CDH is easy to be misdiagmosed and mistreated due to lack of typical clinical manifestations. Making the definite diagnosis of late-presenting CDH depends on the clinical knowledge, special examination and follow-up.