中老年右半结肠癌患者误诊为阑尾炎的临床分析

Clinical analysis of middle aged and elderly patients with right colon cancer misdiagnosed as appendicitis

目的探讨临床中老年右半结肠癌患者误诊为阑尾炎的原因。方法回顾分析汉中市中心医院2005年1月至2016年12月收治的年龄45岁以上右半结肠癌误诊为阑尾炎的25例患者的临床资料,总结误诊原因及诊治体会。结果 25例右半结肠癌误诊为阑尾炎的患者中,5例患者以急性腹痛为主要症状在我院门诊就诊,20例为从基层医院转入我院诊治患者。25例患者中,23例为结肠腺癌,1例为阑尾粘液腺癌,1例为阑尾类癌。25例患者均经住院治疗,痊愈出院。25例患者均获得随访,生存时间6个月以内3例、6个月至1年5例、1～3年8例、3～5年9例。结论中老年右半结肠癌患者误诊为阑尾炎受多种因素影响,临床上应高度重视急性阑尾炎或阑尾周围脓肿诊断的复杂性,重视阑尾炎与结肠癌的临床鉴别诊断。中老年急性阑尾炎或阑尾周围脓肿患者需常规进行检查,必要时行结肠造影检查,对于查体发现右下腹包块的患者,要进行腹部超声、下腹部CT或者纤维结肠镜检查,同时进行血清肿瘤标志物检测,排除结肠癌,明确诊断,减少误诊或漏诊,避免给患者造成无可挽回的后果。

Objective To investigate the causes of misdiagnosis in middle aged and elderly patients with right colon cancer misdiagnosed as appendicitis. Methods Clinical data of 25 cases of patients older than 45 years with right colon cancer who were misdiagnosed as appendicitis in Hanzhong Central Hospital from January 2005 to December 2016 were retrospectively summrize to analyze the causes of misdiagnosis and experience of diagnosis and treatment. Results Among the 25 cases of patients who were misdiagnosed as appendicitis, 5 patients with acute abdominal pain came to treat in the outpatient department of our hospital, and 20 patients were transferred from the primary hospital to our hospital. Among the 25 eases of patients, 23 cases were identified as adenocarcinoma of colon, 1 ease was appendix mucinous adenocareinoma, and the other 1 ease was appendiceal earcinoid. All the 25 patients were cured and discharged from hospital. All the 25 patients were followed up, the survival time of 3 eases was less than 6 months, 5 eases was 6 months to 1 years, 8 eases was 1 years to 3 years, 9 eases was 3 years to 5 years. Conclusion There are many affecting factors in middle aged and elderly patients with right colon cancer misdiagnosed as appendicitis, the diagnostic complexity of acute appendicitis or appendiceal abscess and clinical differential diagnosis of colon cancer should be paid more attention. Routine examination is necessary for middle aged and elderly patients with acute appendicitis or appendiceal abscess, If necessary, radiography should be carried out. For patients who have been examined for finding the right lower abdominal mass, abdominal ultrasound, abdominal CT or fiber colonoscopy should be performed, meanwhile, serum tumor markers should be detected to exclude colon cancer, reduce misdiagnosis or missed diagnosis, avoid irreparable outcomes to the patient.