急性阑尾炎误诊原因分析及预防对策

Pancreatic hemangioma:a case report and review of literature

目的:探讨急性阑尾炎误诊原因和预防措施。方法:回顾性分析我院在2005年1月至2012年12月期间施行的1 826例阑尾切除病例资料。结果:发现58例其他疾病被误诊为急性阑尾炎而误手术,总误诊率为3.18%。术中即刻明确为误诊的共51例,术后才明确为误诊的共7例。结论:误诊原因分三大类:(1)疾病本身的因素,如阑尾位置变异、异位;(2)医生的因素,多数是由于病史采集不全面、体格检查不全面、不细致、临床经验不足所致;(3)患者的因素;(4)过于依赖模棱两可的辅助检查结果如彩超。预防误诊的主要措施包括:(1)详细的病史采集、全面细致的体检和相关的辅助检查,同时尽可能让辅助检查与临床表现一致;(2)加强专业知识的学习,提高临床诊疗水平;(3)对于孕妇、老年人、小儿临床不典型者,应注意动态观察病情变化,必要时请专科医师会诊,以免漏诊或误诊;(4)抓好术前再诊断和手术适应证。

Objective： To investigate the clinical characteristics, diagnosis and treatment of pancreatic hemangioma. Methods： A retrospective analysis was performed on data from one case of pancreatic hemangioma complicated with rupture and bleeding of the lesion. The data included clinical symptoms, laboratory investigations, imaging studies and treatment. Moreover, a review of related literature was performed. Results： The clinical symptoms, laboratory and imaging findings were not specific of pancreatic hemangioma in this patient. The pre-surgical diagnosis was inconclusive. The patient underwent surgical resection of the lesion. Postoperative pathology showed vascular compartment structure in the tumor which was consistent with the diagnosis of pancreatic hemangioma. The patient was followed up for 18 months and reported good quality of life. There were no complications such as bleeding, pancreatic fistula, or formation of pseudoeyst. Conclusion： Pancreatic hemangioma is clinically rare. The confirmatory diagnosis relies on pathology, while surgical resection is the mainstay treatment, usually with good prognosis.