摘要
目的探讨糖尿病性大疱病(BD)的误诊原因、防范措施,以及负压辅助封闭(VAC)技术的治疗价值。方法回顾性分析2023年8月1例误诊为“烫伤”的成年男性BD患者的临床资料,并进行文献复习。结果本例BD患者有2型糖尿病史15年,因双足底自发性水疱并破溃发黑2个月就诊,被误诊为“烫伤”,治疗后效果不明显。根据患者相关病史以及组织病理活检显示表皮内水疱形成,符合BD的诊断。误诊时间为2个月。确诊后予常规对症治疗,并局部清创、换药后创面愈合缓慢,应用VAC技术创面愈合良好出院。出院后随访13周创面愈合,双足活动正常。结论BD较为罕见,需要鉴别诊断以排除其他类型皮肤病,易误诊。临床医生应加强对该病的认识,详细的病史采集及组织病理活检可避免误诊。对于较大溃疡,在血供允许、感染控制后可联合VAC治疗促进创面愈合。
Objective To explore the causes of misdiagnosis and preventive measures of bullosis diabeticorum(BD),and the value of vacuum-assisted closure(VAC)technique in the treatment of BD.Methods The clinical data of an adult male BD patient who had been misdiagnosed as"scald"in August 2023 were retrospectively analyzed,and the literature was reviewed.Results This BD patient had a history of type 2 diabetes for 15 years,and presented with spontaneous blisters on both plantar and black rupture for 2 months,which was misdiagnosed as"scald".The treatment was not significantly effective.According to the patient's relevant medical history and histopathological biopsy,the formation of intraepidermal blisters was consistent with the diagnosis of BD.The misdiagnosis lasted 2 months.After diagnosis,he was given conventional symptomatic treatment,but wound healing was slow after local debridement and dressing change.Wound healing was good after VAC technique was applied and the patient was discharged.At 13-week follow-up after discharge,the wound healed and the foot activity was normal.Conclusion BD is a relatively rare disease,which requires differential diagnosis to exclude other types of skin diseases and is prone to misdiagnosis.Clinicians should strengthen the understanding of the disease,and detailed history collection and histopathological biopsy can help avoid misdiagnosis.For larger ulcers,VAC technique may be used in combination to promote wound healing after blood supply is sufficient and infection is controlled.
作者
翟筱涵
石鸿雁
张美
李莉琼
王爱红
朱平
ZHAI Xiaohan;SHI Hongyan;ZHANG Mei;LI Liqiong;WANG Aihong;ZHU Ping(Department of Endocrinology,the Ninth Medical Center of PLA General Hospital,Beijing 100101,China)
出处
《临床误诊误治》
2025年第4期1-5,共5页
Clinical Misdiagnosis & Mistherapy
基金
首都卫生发展科研专项(首发2024-2-5131)。
关键词
糖尿病性大疱病
水疱
误诊
烫伤
皮肤溃疡
封闭负压引流
鉴别诊断
Bullosis diabeticorum
Blister
Misdiagnosis
Scald
Skin ulcer
Vacuum-assisted closure
Differential diagnosis
