误诊为阑尾炎的少见疾病的诊治体会

The Experience of Diagnosis and Treatment of Rare Diseases Misdiagnosed as Appendicitis

目的:回顾性分析临床表现极似阑尾炎但后经病检证实为其他疾病的临床诊断及治疗方法,总结临床经验教训,提高对类似疾病的鉴别诊断水平,扩展临床思维。方法:选取我院从2006年5月～2012年8月收治以临床表现极似阑尾炎的其他疾病患者11例,入院后进行一般体格检查、辅助检查(实验室检查、腹部彩超)及术中术后病检确诊,根据术中具体病情采取相应的处理措施,观察分析治疗效果。结果:其中肠结核2例行内科保守治疗,克隆恩病1例术后继行内科治疗,嗜酸性肉芽肿2例、美克尔憩室炎3例、回盲部肿瘤3例行肠切除或肿瘤根治术。结论:腹部外科急腹症中急性阑尾炎是最多见的,典型病例诊断相对较为容易,但临床表现相似的疾病较多,鉴别诊断较为复杂,除与常见病相鉴别外,还应扩展临床思维想到肠结核、克隆恩病、嗜酸性肉芽肿等这些少见病的可能,根据术中具体情况选择适宜的对策。

Objetive： To retrospective analysis on clinical performance as confirmed by pathology of ap- pendicitis clinical diagnosis and treatment for other diseases, summarize the clinical experience, improve the differential diagnosis of similar diseases, expand the clinical thinking. Methods： Select our hospital from May 2006 to August 2012 were treated with clinical performance as appendicitis of 11 patients with other diseases, after admission to general physical examination, assistant examination,intraoperative and postoperative dis- ease diagnosis, according to the specific condition of corresponding treatment measures, and analyze the treatment effect. Results： Intestinal tuberculosis, 2 o{ whom underwent internal medicine conservative treat- ment, 1 case of postoperative crohn＇s disease following the line of medical treatment, 2 cases of eosinophilic granuloma, meckels diverticulitis （3 cases）, 3 regular bowel resection ileocecus tumor or tumor radical oper- ation. Conclusions： Abdominal surgical acute abdomen, acute appendicitis is most common in the diagnosis of typical cases are relatively easy, but similar clinical manifestations of disease is more, the differential diagno- sis is relatively complex, in addition to the phase identification and common diseases, should also be extended clinical thinking think of intestinal tuberculosis, crohn＇s disease, eosinophilic granuloma, etc. The possibility of this rare disease, according to the specific situation to choose suitable countermeasures intraoperative.