以腹痛为首发症状的Stanford B型主动脉夹层误诊分析

Misdiagnosis of Stanford B Aortic Dissection with Abdominal Pain as the First Symptom

目的探讨以腹痛为首发症状的Stanford B型主动脉夹层(aortic dissection,AD)误诊原因及防范对策。方法回顾性分析我科2014年4月—2017年6月收治的以腹痛为首发症状的Stanford B型AD 10例误诊病例资料。结果 10例均以腹痛为首发症状急诊入院,其中4例收入消化内科,3例收入胃肠外科,2例收入心内科,1例收入肝胆外科。10例均首诊误诊,分别误诊为胃肠炎及急腹症各3例,急性心肌梗死2例,胰腺炎及胆囊炎各1例。10例经相关科室治疗后腹部疼痛减轻不明显,后怀疑AD,经主动脉CT造影(CTA)检查确诊为Stanford B型AD,误诊时间5 h^14 d。确诊后均行主动脉腔内覆膜支架修复术,9例术后恢复良好出院,1例术后因肾衰竭死亡。结论 AD临床表现多样,缺乏特异性,特别是以腹痛为首发症状者易被误诊。在中老年急性腹痛患者鉴别诊断中应考虑到AD可能,及早行主动脉CTA有助于确诊。

Objective To assess the causes of misdiagnosis of Stanford B aortic dissection(AD)with abdominal pain as the first symptom,and to discuss its preventive method.Methods Data of 10 patients suffering from Stanford B AD with abdominal pain as the first symptom admitted to our department from April 2014 to June 2017 were retrospectively analyzed.Results A total of 10 patients were admitted to our hospital in emergency for abdominal pain as the first symptom.Including 4 in Gastroenterology Department,3 in Department of Gastrointestinal Surgery,1 in Department of Hepatobiliary Surgery,and 2 in Department of Cardiology.All 10 cases were misdiagnosed at initial visit,including 3 misdiagnosed as gastroenteritis,3 as acutel abdomen,2 as acute myocardial infarction,1 as pancreatitis,and 1 as cholecystitis.Abdominal pain was not relieved in all 10 patients after treatment by the relevant departments.AD was suspected and then confirmed by aortic CTA examination.Duration of misdiagnosis was 5 h-14 d.All patients were treated by endovascular stent graft repair.Of them,9 patients were discharged home after recovery,and 1 died of renal failure.Conclusion The clinical manifestations of AD are diverse and lack of specificity,thus contributing to misdiagnosis,especially in those with abdominal pain as the initial symptom.AD should be taken into consideration in middle aged to elderly patients with acute abdomen,therefore,timely aortic CTA is helpful in diagnosis of AD.