102例胰腺癌诊断探讨

Exploration of the Diagnosis for 102 Cases of Pancreatic Carcinoma

目的 分析胰腺癌误诊和漏诊的原因 ,缩短首发症状到确诊的时间 ,提高胰腺癌早期诊断率和切除率。方法 回顾性分析 1991年至 1997年我院收治的 10 2例胰腺癌入院前诊断情况及住院后各项检查的诊断率。结果 首次症状到入院的时间平均为 197d ,首次黄疸至入院的时间平均为 6 0d ,首次院外就诊时误漏诊率 10 0 % ,院外多次就诊或住院后误诊率和漏诊率达 85 % ,,其中误诊最多的为消化性溃疡 (2 5例 ) ,其次是胆石症 (14例 )、肝炎 (11例 )、胆道蛔虫 (5例 )、骨质增生 (3例 )、结肠炎 (3例 )、其它 (3例 ) ,院外手术 8例 ,有 7例术中漏误诊 ;住院后超声诊断符合率 85 % ,CT诊断正确率 95 % ,术中发现腹腔广泛转移 6 0 % ,同时伴肝转移 40 % ,伴局部侵犯及淋巴转移 75 % ,根治术 10 % ,姑息切除 2 % ,非手术 10 %。结论 胰腺癌误漏诊率高 ,误漏诊时间长 ,根治率低 ,提高首次诊断率以缩短误诊时间是当务之急 ,尽早CT检查是目前最佳的手段。

Objective To study the cause of misdiagnosis of pancreatic carcinoma(PC) in order to obtain the final diagnosis as early as possible,and increase the rates of early diagnosis and resection of PC.Mothods We petrospectively reviewed 102 cases of PC from 1991 to 1997,and analyzed the diagnostic accuracy of prehospitalized and admitted for PC.Results The average time from initial symptoms and jaundices to admision was 197 days and 60 days,respectively.The misdiagnostic rates of the first consult and multicosult or hospitalized in other hospitals were 100% and 85%,respectively.The most frequently misdiagnostic disease was peptic ulcer(25 cases),the rest were cholelithiasis(14 cases),hepatitis(11 cases),biliary tract ascarides(5 cases).Osteophyte proliferation(3 cases),colilis(3 cases) and others(3 cases).8 cases underwent surgery in other hospitals while 7 cases of them misdiagnosis in operation.The diagnostic rates of B-U and CT after admison were 85% and 95%,respectively.According to operative findings,60% cases had wide-ranging celiac metastasis in which 40% had hepatic metastasis simultaneously,alse 75% had local invasion and lymphatic metastasis.Only 10% and 2% patients underwent radical resection and palliative surgery respectively, while 10% patients had conservative treatment.Conclusion We demonstrated that there are high misdiagnositic rate,low radical rate and delaying final diagnosis for PC.It is urgent to increase its initial diagnostic rate and apply for CT in early stage would be the best device.