摘要
目的总结慢性胆囊炎误诊为胆囊癌的原因及防范措施。方法回顾性分析误诊为胆囊癌的慢性胆囊炎10例的临床资料。结果本组3例无明显临床症状,因体检时发现胆囊占位性病变就诊,查体无腹部压痛等阳性体征;6例出现阵发性右上腹痛;1例因突发全腹痛8 h入院。本组均无肩背部放射性疼痛,术前均行腹部CT和(或)MRI检查,可见胆囊壁均有不规则增厚。10例术前均误诊为胆囊癌,在完善相关检查评估无手术禁忌证后行手术治疗,其中9例行术中快速冷冻病理检查,考虑为慢性胆囊炎;10例术后常规病理检查均诊断为慢性胆囊炎。2例因术后苏醒延迟及血流动力学不稳定转入重症监护病房治疗,病情平稳后转入普通病房。所有患者术后均给予抗感染等常规治疗,并对术前基础疾病给予相应药物治疗。合并低蛋白血症3例,严重低钾血症2例,肺炎和胆漏各1例,经过积极保守对症处理后症状好转。所有患者均康复出院。出院后随访半年,2例进食后出现反酸及活动后右上腹隐痛,8例无腹痛、发热和黄疸等异常表现。结论对于临床表现不典型、影像学检查不排除胆囊癌的患者,术中快速冷冻病理检查鉴别诊断慢性胆囊炎和胆囊癌具有指导意义,同时加强多学科诊疗或能避免误诊的发生。
Objective To summarize the causes and preventive measures of misdiagnosis of chronic cholecystitis as gallbladder cancer.Methods The clinical data of 10 patients with chronic cholecystitis misdiagnosed as gallbladder cancer was retrospectively analyzed.Results Three patients in this group had no obvious clinical symptoms,but presented to our department due to space-occupying lesion in gallbladder found during physical examination,and no positive signs such as abdominal tenderness were found.Paroxysmal right upper abdominal pain occurred in 6 cases.One case was hospitalized for sudden total abdominal pain for 8 h.There was no radiation of the pain to the back or shoulder.Preoperative CT and/or MRI examinations of the abdomen were performed in this group,showing irregular thickening of the gallbladder wall.All the 10 cases were misdiagnosed as gallbladder cancer before surgery,and surgical treatment was performed after relevant examination and assessment without contraindications.Among them,9 cases underwent rapid intraoperative cryopathological examination and were considered as having chronic cholecystitis.All the 10 cases were diagnosed as chronic cholecystitis by conventional pathological examination.Two cases were transferred to intensive care unit due to delayed postoperative resuscitation and hemodynamic instability,and then transferred to general ward after stable condition.All patients were given conventional treatment such as anti-infection after operation,and corresponding drug treatment was given for basic diseases before operation.There were 3 cases complicated with hypoproteinemia,2 cases with severe hypokalemia,1 case with pneumonia and 1 case with biliary leakage.After aggressive and conservative symptomatic treatment,the symptoms were improved,and all the patients were discharged from hospital after recovery.The patients were followed up for six months after discharge.Two cases had acid reflux and dull pain in the right upper abdomen after food intake and 8 cases had no abnormal manifestations such as abdominal pain,fever and jaundice.Conclusion For patients with atypical clinical manifestations,when gallbladder cancer is not excluded by imaging examination,rapid intraoperative cryopathological examination is of guiding significance for the differential diagnosis of chronic cholecystitis and gallbladder cancer,and strengthening multidisciplinary diagnosis and treatment may avoid misdiagnosis.
作者
张文卓
姚立彬
邵永
侯栋升
李超
洪健
孟松
王辉
朱孝成
ZHANG Wen-zhuo;YAO Li-bin;SHAO Yong;HOU Dong-sheng;LI Chao;HONG Jian;MENG Song;WANG Hui;ZHU Xiao-cheng(Department of General Surgery,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221006,China)
出处
《临床误诊误治》
2020年第9期1-5,共5页
Clinical Misdiagnosis & Mistherapy
基金
徐州市科技计划项目重点研发计划(KC17201)。
关键词
慢性胆囊炎
误诊
胆囊肿瘤
病理学
腹痛
Cholecystitis,chronic
Misdiagnosis
Gallbladder neoplasms
Pathology
Abdominal pain
