小儿急性阑尾炎误诊18例临床分析

Clinical Analysis of Misdiagnosis in 18 Children with Acute Appendicitis

目的探讨小儿急性阑尾炎的临床特点及误诊原因,减少误诊误治。方法回顾性分析误诊为其他疾病的18例小儿急性阑尾炎的临床资料。结果本组误诊时间10 h^6 d,平均2.5 d;误诊为肠系膜淋巴结炎6例,误诊为急性胃肠炎4例,误诊为食物中毒3例,误诊为肠梗阻、药物不良反应各2例,误诊为过敏性皮炎1例。入院后给予相应治疗后症状均未好转,后进一步完善相关检查,考虑急性阑尾炎,均行手术治疗,术后病理检查证实为急性阑尾炎。结论小儿急性阑尾炎临床表现多种多样,提示临床医师要细心地询问病史及查体,正视医技检查的重要性和局限性,认真做好鉴别诊断,以降低误诊率。

Objective To investigate the clinical characteristics and causes of misdiagnosis in children with acute appendicitis,and to reduce the misdiagnosis and mistreatment.Methods The clinical data of 18 children with acute appendicitis who were misdiagnosed as other diseases were retrospectively analyzed.Results The duration of misdiagnosis was 10 h-6 d,with an average time of 2.5 d.There was misdiagnosis as adenomesenteritis in 6 cases,acute gastroenteritis in 4 cases,food poisoning in 3 cases,intestinal obstruction in 2 cases,adverse drug reaction in 2 cases,and allergic dermatitis in 1 case.After admission,the symptoms were not improved after the corresponding treatment.They were diagnosed as acute appendicitis according to relevant further examinations and then received surgery.Postoperative pathological examination confirmed acute appendicitis.Conclusion The clinical manifestations of acute appendicitis in children are diverse.Therefore,careful inquiry about the medical history and physical examination,understanding of the importance and limitations of medical examinations,and careful differential diagnosis are recommended to clinicians to reduce misdiagnosis rate.