多排螺旋CT急诊检查结肠病变误诊与漏诊原因分析

发布时间：2018-06-26 00:13

本文选题：结肠成像 + 计算机体层摄影　；参考：《中国全科医学》2015年17期

【摘要】：目的分析多排螺旋CT检查结肠病变误诊与漏诊原因。方法收集2012年9月—2014年10月于石河子市人民医院行急诊结肠多排螺旋CT检查误诊或漏诊的9例患者临床资料,最终均经活检或手术病理明确诊断,分析其误诊或漏诊原因。结果 9例患者中误诊6例,漏诊3例。3例肠痉挛、炎性病变均误诊为结肠癌,经CT复诊行肛管结肠充气后扫描,未见初次CT扫描所见肠内"肿块影",纤维结肠镜检查未见异常组织;1例阑尾黏液囊肿误诊为右侧卵巢囊腺瘤,后经手术病理证实;1例直肠中分化腺癌、1例回盲部溃疡性中分化腺癌误诊为炎性病变。3例漏诊患者经手术病理证实为1例直肠腺癌,1例乙状结肠腺癌及1例升结肠腺癌。结论误诊、漏诊的主要原因是肠道清理及充气准备不佳、对"假肿块"CT征象认识不足。充分的肠道清洁及充气准备,认真区别"假肿块"CT征象,可有效降低结肠病变的误诊、漏诊概率。
[Abstract]:Objective to analyze the causes of misdiagnosis and missed diagnosis of colonic lesions by multi-slice spiral CT. Methods from September 2012 to October 2014, the clinical data of 9 patients who were misdiagnosed or missed by emergency colonic multi-slice spiral CT examination in Shihezi people's Hospital from September 2012 to October 2014 were collected. The diagnosis was confirmed by biopsy or surgery and pathology, and the causes of misdiagnosis or missed diagnosis were analyzed. Results among 9 cases, 6 cases were misdiagnosed, 3 cases missed diagnosis, 3 cases were intestinal spasm, all inflammatory lesions were misdiagnosed as colon cancer. No "mass shadow" was found in the first CT scan, and one case of mucocele of appendix was misdiagnosed as right ovarian cystadenoma by fiberoptic colonoscopy. One case of middle differentiated adenocarcinoma of rectum and one case of ileocecal ulcerative middle differentiated adenocarcinoma were misdiagnosed as inflammatory lesions. 3 cases were confirmed by surgery and pathology as 1 case of adenocarcinoma of rectum and 1 case of adenocarcinoma of sigmoid colon and one case of ascending colon adenocarcinoma. Conclusion the main causes of misdiagnosis and missed diagnosis are poor preparation for intestinal tract cleaning and inflation, and insufficient understanding of CT signs of "false mass". Adequate preparation for intestinal cleaning and aeration and careful differentiation of CT signs of "false masses" can effectively reduce misdiagnosis and missed diagnosis of colonic lesions.
【作者单位】：新疆石河子市人民医院影像中心;石河子市纺织医院外妇科;
【分类号】：R574.62;R816.5

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