以急性阑尾炎首发的右半结肠癌36例漏诊原因分析

Analysis of the Misdiagnosis Cause of 36 Cases of Right Hemicolon Carcinoma Presenting as Acute Appendicitis

目的分析以急性阑尾炎首发的右半结肠癌围术期的漏诊原因,探讨提高结肠癌早期诊断率的措施。方法回顾性分析我院2000年1月—2011年8月收治的36例以急性阑尾炎为首发表现的右半结肠癌漏诊病例的临床资料。结果36例均以右下腹痛为主要表现就诊,其中30例有典型转移性右下腹痛,36例皆按急性阑尾炎行手术治疗,术中均证实急性阑尾炎。30例术中继续探查发现右半结肠癌;6例术中再次漏诊,术后腹痛不缓解,经纤维结肠镜检查确诊右半结肠癌,再次手术。32例行右半结肠切除术,3例行姑息性切除术,1例术中发现回盲部癌广泛转移并局部梗阻行回结肠短路手术。结论以急性阑尾炎为首发表现的右半结肠癌易漏诊,故对急性阑尾炎患者术中应仔细探查,不能满足已发现的阑尾病变;术后注意观察病情变化,腹痛不缓解时及时行结肠镜等检查,以尽早明确诊断。

Objective To analyze the misdiagnosis cause of right hemicolon carcinoma presented as acute appendicitis in order to explore the measure of improving early diagnosed rate. Methods Clinical data of 36 cases with right hemicolon carcinoma presented as acute appendicitis during January 2000 and August 2011 were retrospectively analyzed. Results All the 36 cases were admitted for right hypogastralgia, and among them, 30 cases were typical metastatic right hypogastralgia. The 36 cases underwent surgery for acute appendicitis and were attested as acute appendicitis intraoperative. The 30 cases were diagnosed with right hemicolon carcinoma by further intraoperative examination, 6 cases were misdiagnosed again and underwent a second surgery for abdominal pain, which was diagnosed as right hemicolon carcinoma by fibercolonscopy. 32 cases underwent right hemicolectomy,3 cases underwent palliative resection and 1 case underwent ileocolic short-circuited operation for widespread changed ileocecal junction cancer combined with local obstruction found intraoperative. Conclusion The right hemicolon carcinoma presented as acute appendicitis may be earlily missed-diagnosed. The patient＇s condition should be closely observed postoperatively, colonoscope examination should be performed to definitely diagnose if abdominal pain still exists.