骨肉瘤误诊误治原因、后果分析及对策  

Misdiagnosis and mistreatment for osteosarcoma: analysis of cause and its strategy

作　　者：姚阳[1] 陶钧[1] 唐晓春[1] 林峰[1] 郭跃武[1] 赵晖[1] 孙元珏[1] 蔡讯[1] 

机构地区：[1]上海交通大学附属第六人民医院肿瘤内科,上海200233

出　　处：《肿瘤》2005年第6期616-618,共3页Tumor

摘　　要：目的探讨骨肉瘤误诊误治的各种原因、后果及其治疗方法。方法收集我科47例有误诊、误治病史的骨肉瘤患者临床资料,并对误诊、误治的后果进行回顾性分析。结果因病人因素造成误诊18例(38．30％),医师因素17例(36．17％),病人和医师双方因素12例(25．53％),平均误诊天数分别为72．15、57．34、100．68d。27例(57．45％)有误治史,其中14例(29．79％)曾行中医药治疗,11例(23．40％)接受不正确手术治疗,误用抗生素治疗2例。误诊、误治有可能导致28例(59．57％)失去保肢手术的机会,8例(17．02％)保肢手术后复发,20例(42．55％)出现远处转移。结论骨肉瘤误诊、误治的主要原因是患者、家长延误,加之临床和影像学诊断医师缺乏骨肉瘤专业知识所致,CT或MRI检查是防止早期骨肉瘤误诊的最有效的方法,对于不典型病例手术或活检前应充分估计到各种诊断的可能性,并制定完善的治疗方案,切忌盲目采取任何治疗。Objective To investigate various kinds of causes and consequences for misdiagnosis and mistreatment of osteosarcoma （OS）. Methods The data from 47 patients with osteosarcoma undergoing misdiagnosis and mistreatment were collected and their clinical causes and consequences were analyzed retrospectively. Results The causes contributing to the misdiagnosis among 47 patients included that patients delayed consulting their doctor （18 cases ,38.3 % ）, patients underwent medical misdiagnosis and both of components occurred simultaneously（ 12 cases, 25.53 %）. The average duration of misdiagnosis was 72. 15 d, 57.34 d and 100.68 d, respectively. Fourteen cases （29.79 %） accepted traditional Chinese medicine therapy, 11 （23.40 %） cases were treated by incorrect operation. Perhaps there were 28 patients （59.57%）loosed limb-salvage procedure opportunity, 8 patients （17.02 %） had recurrence after limb-salvage operation, 20 patients （42.55 % ） underwent metastasis induced by misdiagnosis and mistreatment. Conclusions The main cause of misdiagnosis and mistreatment of OS is medical misdiagnosis, patients and their parents have deficient professional knowledge of OS. CT and MRI examinations are the most effective procedures to prevent the misdiagnosis of early OS. The probability of all kinds of diagnoses should be estimated sufficienty, the therapeutic protocol should be made consummately and any other treatment procedures should not be taken blindly for the atypical cases before operation or biopsy.

关 键 词：骨肿瘤 骨肉瘤 诊断 治疗学 

分 类 号：R738.7[医药卫生—肿瘤]