小儿阑尾炎误诊分析

Analysis on misdiagnosis of the appendicitis in childhood

目的 分析小儿阑尾炎的误诊原因 ,降低小儿阑尾炎的误诊率 ,减少术后并发症的发生。方法 回顾我院外科 1997～ 2 0 0 2年误诊的 2 2 5例急性阑尾炎的临床资料 ,通过对其病史、手术所见 ,实验室及辅助检查结果进行回顾性研究 ,分析误诊原因。结果 术前诊断为其他疾病 ,手术确诊为阑尾炎的 16 3例 ;术前诊断为阑尾炎 ,手术证实为其他疾病的 6 2例。全部病例均经手术治疗 ,术后痊愈出院 ,并发症的发生率为 16 .4 4 %。结论 对小儿急性阑尾炎的临床症状特点缺乏足够的认识 ,腹部体征的掌握不准确及过多的依赖辅助检查是误诊的主要原因。对酷似阑尾炎的病例 ,应当允许阑尾误切的存在 ,但应注意诊断和鉴别诊断 ,尽量减少误切。

Objective To analyse the reasons of misdiagnosis of appendicitis in children and find methods to decrease the misdiagnosis rate and the incidence of postoperative complications. Methods 225 acute appendicitis cases which were misdiagnosed in our hospital from 1997 to 2002 were analysed. The histories, operation findings and examination results of all cases were retrospective studied to define the misdiagnosis reasons. Results 163 acute appendicitis cases were diagnosed after the operations, which were misdiagnosed as other diseases before the operations. 62 patients with other diseases were misdiagnosed and acute appendicitis was diagnosed after operations. All cases treated by operations were all cured, and the complication rate was 16.44%. Conclusions Lack of understanding of the clinical symptoms and mastering of the exact abdominal physical signs of the acute appendicitis in children and over dependence on the assistant examinations are the main reasons for misdiagnosis. In the patients who are difficult to discriminate from real acute appendicitis, decision of appendicectomy is permitted. However, the diagnosis and the differential diagnosis of acute appendicitis should be emphasized so as to reduce the misdiagnosis rate.