癌症患者非癌性疼痛八例误诊分析

Misdiagnosis of 8 Cases Non Cancer Chronic Pain in Cancerous Patients

目的 探讨癌症患者非癌性疼痛的误诊原因。方法 对首都医科大学宣武医院近年收治的癌症患者非癌性疼痛8例误诊资料进行回顾性分析。结果 8例在肿瘤手术或放化疗结束后2-6个月出现疼痛,性质多为酸胀痛、牵拉痛、放射痛或烧灼痛,程度多较剧烈,呈持续性、阵发性加重。2例肺癌术后和（或）放化疗后颈肩部疼痛,误诊为原发癌复发转移;胸腺瘤放疗后胸背部疼痛、肾癌术后腰部疼痛各2例,均误诊为癌性疼痛;2例肺癌术后胸痛,误诊为肿瘤胸膜、胸壁转移。后经详细查体、影像学检查及认真鉴别诊断,确诊为颈源性疼痛、胸椎源性神经痛、腰椎源性疼痛及开胸术后疼痛综合征各2例。确诊后予选择性神经阻滞、神经根热凝射频、神经节脉冲射频等治疗,疼痛症状均得到不同程度改善。结论 癌症患者疼痛原因多样,肿瘤并非疼痛唯一病因,加之疼痛性质较复杂,易误诊;重视病史采集,仔细查体,拓宽诊断思维,选择恰当的医技检查方法,多可避免误诊误治。

Objective To investigate the cause of misdiagnosis of non cancer chronic pain of cancerous patients. Methods 8 clinical cases of misdiagnosis of non cancer chronic pain as cancer pain form our hospital are retrospectively analyzed. Results 8 cases had pains 2-6 months after surgical or chemotherapy. The pains were ache, radiating and scorching pains, mostly intensive and continuous, but aggravating intermittently. Two of the eight cases of cervicogenie pain were misdiagnosed as cancer metastasity after lung cancer. 2 clinical cases of thoracic neuralgia post-thoracic radiotherapy were misdiagnosed as cancer pain. Another 2 clinical cases of lumber discogenic pain after operation of kidney carcinoma were misdiagnosed as cancer pain. The other 2 cases of post-thoracotomy syndrome were misdiagnosed as Cancer metastasis. After detailed physical examination and imaging examination, the diagnosis was 2 cases of cervical source pain, thoracic spinal pain, lumbar pain and open chest surgery pain respectively. After diagnosis, the pain symptoms were improved to different degrees after the treatment of selective nerve block, nerve root coagulation radio frequency and ganglion impulse radio frequency. Conclusion The causes of chronic pain of cancerous patients are multiple and cancer is not the only pathogenesis of cancer pains. The nature of the pains is miscible and may be misdiagnosed. Medical history, physical examinations, broad diagnostic thinking and appropriate medical technological measures are essential in prevention of misdiagnosis and mistreatment.