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目的分析回盲部结肠癌误诊为阑尾炎的原因及如何避免误诊的方法。方法回顾性分析1998年1月2010年10月误诊为阑尾炎的回盲部结肠癌患者30例的临床资料。其中男24例,女6例;年龄14～78岁,平均56岁。30例患者均行手术治疗,阑尾切除术中发现回盲部结肠癌28例而改行其他术式,其中一期右半结肠癌根治术12例,姑息性右半结肠切除术5例,回肠横结肠短路术6例,二期手术5例;1例于阑尾切除术后15d发现回盲部结肠癌,行右半结肠癌根治术;1例于阑尾切除术后6个月因肠梗阻明确诊断而再次手术,行右半结肠癌根治术。20例术后行全身静脉联合化学疗法治疗。结果术后发生切口感染6例,经局部换药、抗感染及支持等治疗后切口丙级愈合;其余切口均甲级愈合。术后无肠漏发生。住院时间12～68d,平均18d,住院期间无死亡者。所有患者术后病理检查均证实为回盲部结肠腺癌,其中合并阑尾炎28例。20例获随访,随访时间3个月～12年,平均5.6年。6例因无法切除病灶而行回肠横结肠吻合短路手术,于术后6～15个月死亡;5例行姑息性右半结肠切除术,于术后9～27个月死亡;余9例随访2～12年无复发。同期收治回盲部结肠癌167例,误诊、漏诊率为18%。结论回盲部结肠癌有时易误诊为阑尾炎,或并发阑尾炎时易漏诊;应仔细询问病史,全面了解和掌握患者的病情,完善必要的辅助检查,不要盲目自信是防止误诊、漏诊的关键。
Objective To analyze the causes of misdiagnosis of colon cancer in ileocecal part as appendicitis and how to avoid misdiagnosis. Methods The clinical data of 30 patients with ileocecal colon cancer who were misdiagnosed as appendicitis in January 1998 and October 2010 were retrospectively analyzed. Including 24 males and 6 females; aged 14 to 78 years, mean 56 years. Thirty patients underwent surgical treatment. 28 cases of ileocecal colon cancer were found in appendectomy and other procedures were switched to. Among them, 12 cases were treated with right-sided colon cancer in the first stage, 5 cases with palliative right-half colon resection, Short-circuit surgery in 6 cases, 2 cases of surgery in 5 cases; 1 case of 15 days after appendectomy found ileocecal colon cancer, right colon cancer radical surgery; 1 case of appendectomy 6 months due to intestinal obstruction clear diagnosis Reoperation, right colon cancer radical surgery. Twenty patients underwent systemic vein chemotherapy combined with chemotherapy. Results Postoperative incision infection in 6 cases, after local dressing, anti-infection and support treatment of incision C healed; the other incisions were grade A healed. No intestinal leakage occurred. Hospitalization time 12 ~ 68d, an average of 18d, no death during hospitalization. Postoperative pathological examination of all patients confirmed as ileocecal colon adenocarcinoma, which merged appendicitis in 28 cases. Twenty patients were followed up for 3 months to 12 years with an average of 5.6 years. 6 cases of unresectable lesions and transverse ileocolic anastomosis short circuit surgery, 6 to 15 months after the death; 5 cases of palliative right hemi-colon resection, 9 to 27 months after the death; the remaining 9 cases were followed up 2 ~ 12 years without recurrence. The same time, ileocecal treatment of colon cancer 167 cases, misdiagnosis, misdiagnosis rate was 18%. Conclusion Ileocecal colon cancer is sometimes misdiagnosed as appendicitis, or easily missed when complicated with appendicitis; history should be carefully asked to fully understand and grasp the patient’s condition, improve the necessary auxiliary examination, do not blindly self-confidence is the key to prevent misdiagnosis, missed diagnosis.