高龄老年直肠癌47例临床特点及误诊分析

Clinical Characteristics and Cause Analysis on Misdiagnosis of Colorectal Cancer in Elderly Patients

目的探讨高龄老年直肠癌的临床特点及误诊原因,降低误诊率。方法回顾性分析2009年12月—2014年1月吉林省肿瘤医院收治的高龄老年直肠癌47例误诊病例资料。结果本组平均年龄78.8岁,伴有多种基础疾病,主要表现为排便习惯改变、便血或黑便,3例以急性肠梗阻症状首发,2例出现左下腹包块。均多次在外院诊治,多首诊于社区或乡镇卫生院综合内科和消化内科。均于外院误诊,误诊为结肠炎15例、痔14例、习惯性便秘7例、直肠炎6例、肛裂3例、痢疾2例。就诊我院后经手术探查和结肠镜活组织病理检查确诊,行手术或保守治疗并部分联合放化疗。随访12~36个月死亡28例,1年生存率57.4%、3年生存率40.4%。结论提高对高龄老年直肠癌的认识,重视直肠指诊和结肠镜检查,可避免直肠癌的误漏诊。

Objective To explore the features of misdiagnosed elderly rectal cancer patients,to analyze the misdiagnosis causes and precautionary measures. Methods Clinical data of 47 misdiagnosed elderly samples during December 2009 and January 2014 were retrospectively analyze. Results The average age was 78. 8 years,accompanied with many basic diseases. Clinical manifestations included： change of habit of bowel loosening,hematochezia and black stool. 3 patients had acute intestinal obstruction at onset and 2 patients had lumps in the left lower abdomen. They were diagnosed with operation or pathology. They had been misdiagnosed as enteritis（ 15 cases）,hemorrhoids（ 14 cases）,habitual constipation（ 7 cases）,rectitis（ 6 cases）,anal fissure（ 3 cases） and dysentery（ 2 cases） before admission to our hospital. In the follow-up study,28 patients died during 12-36 months of follow-up and 1 year survival rate and 3 year survival rate was 57. 4% and 40. 4% respectively. Conclusion Improving the understanding of the disease,paying great attention to rectal touch and colonoscopy are essential to avoid misdiagnosis of rectal cancer.