妇科急腹症误诊急性阑尾炎89例分析

Analysis of 89 cases with gynecological acute abdomen misdiagnosed as acute appendicitis

目的探讨误诊为急性阑尾炎的妇科急腹症的临床特征。方法连续收集首诊被误诊的妇科急腹症患者资料89例,分析全组患者的年龄分布、妇科疾病分布及阑尾炎类似症状的出现频率。结果全组30～40岁的患者51例(57.3%),所占比例最大。被误诊频率最高的前3个妇科疾病是盆腔炎(37例)、右侧输卵管炎(26例)、右卵巢囊肿蒂扭转(19例)。盆腔炎中转移性右下腹痛和腹膜刺激体征的出现频率明显高于右侧输卵管炎、右卵巢囊肿蒂扭转(P<0.05)。结论女患者尤其是30～40岁的女患者右下腹痛,应首先与妇科疾病如盆腔炎、右侧输卵管炎、右卵巢囊肿蒂扭转等鉴别,要多借助现代超声技术进行鉴别诊断。

Objective To investigate the clinical feature of gynecological acute abdomen misdiagnosed as acute appendicitis. Methods A continuous clinical data of 89 cases with acute abdomen misdiagnosed as acute appendicitis was included in this study to analyse the age distribution, gynecological diseases distribution and the frequency of similar symptoms of acute appendicitis. Results The proportion of cases aged 30 to 40 was the largest. Pelvic inflammatory disease（37 cases）, right salpingitis （26 cases）and right ovarian cyst torsion （19 cases） were the roost frequently misdiagnosed. The occurrence rate of metastatic right lower abdominal pain and peritoneal irritation signs were significantly higher than that of right salpingitis group and right ovarian cyst torsion group （ P 〈 0. 05 ）. Conclusion The symptom of right lower abdominal pain of female patients, especially for those aged 30 to 40, should be identified with gynecological diseases firstly, sueh as pelvic inflammatory disease, right salpingitis and right ovarian cyst torsion. It is necessary to use modem ultrasound technology in differential diagnosis.