老年胆总管结石30例误诊分析

Misdiagnosis of 30 Cases of Choledocholithiasis in the Elderly

目的探讨老年胆总管结石误诊原因,以减少临床误诊误治。方法回顾性分析2018年9月-2019年9月内蒙古科技大学包头医学院第二附属医院收治的曾误诊的老年胆总管结石患者30例的临床资料。结果本组间断腹胀、便秘15例,其中8例误诊为功能性消化不良,7例误诊为慢性胃炎;3例畏寒、发热,1例寒战、高热,误诊为呼吸道感染;3例后背困痛误诊为胆囊炎;2例反酸、胃灼热误诊为胃食管反流病;2例因寒战、高热误诊为感染性疾病;2例因皮肤黄疸误诊为胆管恶性肿瘤;1例胸闷、气短误诊为劳力性心绞痛;1例头晕、头痛伴乏力、贫血误诊为后循环缺血。本组误诊时间1周~1年。30例分别按照误诊疾病治疗后部分患者症状仍间断发作或加重,复查肝功能出现异常,完善腹部MRI+磁共振胰胆管造影或超声内镜或内镜下逆行胰胆管造影后确诊胆总管结石。结论老年胆总管结石临床表现不典型易误诊,详细问诊,全面评估,及时行生化、腹部彩超、MRI等检查,可减少胆总管结石误诊情况的发生。

Objective To explore the cause of misdiagnosis of choledocholithiasis in the elderly, so as to reduce the misdiagnosis and mistreatment in clinical practice. Methods We retrospectively analyzed the clinical data of 30 elderly patients with choledocholithiasis that were treated in the Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology. Results Of all patients, 15 patients presented with abdominal distension and constipation, including 8 patients misdiagnosed as having functional dyspepsia and 7 patients misdiagnosed as having chronic gastritis. In addition, 3 persons having a fever and chill and 1 person having rigor and high fever were misdiagnosed as having respiratory disease. Two persons having regurgitation and heartburn were misdiagnosed as having gastroesophageal reflux disease, and three persons having back pain were misdiagnosed as having cholecystitis. Two persons having skin jaundice were misdiagnosed as having cholangiocarcinoma, 1 person having tightness in the chest and shortness of breath was misdiagnosed as having angina pectoris, and 1 person having a dizziness and headache accompanied with weakness and anaemia was misdiagnosed as having posterior circulation ischemia. The duration of misdiagnosis was 1 week-1 year. Thirty patients were treated accordingly, however, some patients had intermittent or aggravated symptoms. The liver function abnormalities were detected after reexamination. Based on abdominal MRI+magnetic resonance cholangiopancreatography or ultrasound endoscopic or endoscopic retrograde cholangiopancreatography(ERCP), choledocholithiasis was diagnosed. Conclusion Given atypical clinical manifestations, choledocholithiasis in the elderly is more likely to be misdiagnosed. Detailed inquiry, comprehensive evaluation, timely biochemical examination, abdominal ultrasound and MRI can reduce the occurrence of misdiagnosis of choledocholithiasis.