高脂血症性胰腺炎21例误诊讨论

Misdiagnosis of 21 Cases of Hyperlipidemic Pancreatitis

目的探讨高脂血症性胰腺炎(hyperlipidemic pancreatitis,HLP)的误诊原因及防范措施。方法回顾性分析我院误诊为其他疾病的21例HLP的临床资料。结果本组均表现为腹痛,其中18例伴呕吐,6例伴背部放射性痛,4例有腹胀伴肛门排气、排便减少。误诊时间1～36个月,误诊为急性胃炎11例,肠梗阻4例,胆源性胰腺炎、糖尿病酮症酸中毒各3例,予相应处理症状均未好转。按照《中国急性胰腺炎诊治指南(2013年,上海)》制订的诊断标准,结合临床表现、实验室检查、影像学表现,排除其他病因,均确诊为HLP,予对症治疗后病情缓解。随访1. 5年,病情均未复发。结论 HLP临床表现缺乏特异性,熟练掌握HLP诊断标准,及时行相关检查,可有效避免或减少误诊。

Objective To investigate the causes of misdiagnosis of hyperlipidemic pancreatitis(HLP)and its preventive measures.Methods The clinical data of21cases of HLP misdiagnosed as other diseases in our hospital were analyzed retrospectively.Results All the patients presented with abdominal pain,including18cases with vomiting,6cases with radiation pain in the back and4cases with abdominal distension,anal exhaust and reduced bowel movements.The duration of misdiagnosis ranged from1to36months.Of21cases,11cases were misdiagnosed as acute gastritis,4cases as intestinal obstruction,3cases as biliary pancreatitis and3cases as diabetic ketoacidosis.The symptoms were not improved after symptomatic treatment.According to the diagnostic criteria of"Guidelines for the Diagnosis and Treatment of Acute Pancreatitis in China(2013,Shanghai)",in conjunction with clinical manifestations,laboratory examinations,imaging findings,other causes were excluded,and all patients were diagnosed as HLP,which was relieved after symptomatic treatment.All patients were followed up for1.5years without recurrence.Conclusion The clinical manifestations of HLP are lack of specificity.Mastering the diagnostic criteria of HLP and carrying out relevant examinations in time can effectively avoid and reduce misdiagnosis.