重视眼科影像学检查提高临床诊断率  

Recstruct ophthalmic image examination to improve clinical diagnostic accuracy rate

作　　者：唐东润[1] 张楠[2] 殷海泉[3] 孙丰源[2] 简天明[1] 

机构地区：[1]天津市眼科医院天津医科大学眼科临床学院眼眶病眼整形科, 300020 [2]天津市第一中心医院眼科 [3]阜新市中心医院

出　　处：《中国实用眼科杂志》2010年第5期543-547,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的 总结分析眼科临床出现的误诊和漏诊病例的原因,应重视影像学检查,弥补临床常规检查诊断的不足.方法 对2007年至2008年两年间门诊和住院病人通过各种影像学检查纠正诊断的37例患者进行分析,年龄6～75岁,男性17例,女性20例.结果 在37例患者中,有8例为颈动脉海绵窦瘘（2例外伤性,6例自发性）被诊断为结膜炎或巩膜炎;6例外伤性眶壁线性骨折的儿童被诊断为眼肌麻痹或肌肉断裂,给予保守治疗10至20d无效;2例淋巴瘤和3例泪腺样囊性癌患者被诊断为眼眶炎性假瘤;2例横纹肌肉瘤诊断为眼眶炎症;2例脉络膜黑色素瘤因延误治疗出现眶内蔓延;2例额窦黏液囊肿和1例下直肌缺如诊断为麻痹性斜视;蝶窦颅底病变和眼内占位各1例诊断为知觉性斜视;视神经脑膜瘤和颅内鞍区蝶窦占位各1例诊断为球后视神经炎;1例泪囊鳞癌诊断为泪囊炎;4例骨内血管瘤患者CT软组织窗扫描考虑为骨瘤;2例外伤眶内异物漏诊.结论 通过分析总结可见,颈动脉海绵窦瘘、外伤性眶壁线性骨折、外伤眶内异物等通过病史询问,仔细检查和临床经验辅之以影像学检查可以得到正确诊断;有些病变则应对诊断治疗过程中出现的不同表现和不典型症状,要及时鉴别诊断,进行各种影像学检查,排除其他疾病的存在,避免误诊和漏诊.总之,影像学检查是一种有效和必要的,特别是对眶内和颅内病变的揭示有重要价值,在临床工作中应给予重视.Objective To review and analyze reasons of misdiagnosis and missed diagnosis with the clinical routine eye examination and pay attention to imaging examinations to make up for deficiencies in clinical diagnosis.Methods Thirty-seven outpatients and inpatients of correcting diagnosis by imaging examinations were analyzed retrospectively from 2007 to 2008 at Tianjin Eye Hospital.Among them, 17 were males and 20 female between 6 and 75 years old. Results In 37 patients, 8 cases of carotid-cavernous fistula （2 cases of traumatic, 6 cases of spontaneous） were diagnosed as conjunctivitis or scleritis; 6 cases of traumatic orbital wall linear fracture children were diagnosed with ophthalmoplegia or muscle rupture, conservative treatment for 10 to 20 days was invalid; 2 cases of lymphoma and 3 cases of adenoid cystic carcinoma were diagnosed with orbital inflammatory pseudotumor; 2 cases of orbital rnabdomyosarcoma were diagnosed with inflammation; 2 cases of choroidal melanoma with orbital spread due to delay in treatment; 2 cases of frontal sinus mucous cyst and 1 case of absence of inferior rectus were diagnosed as paralytic strabismus; 1 case of sphenoid sinus skull base lesions and 1 case of intraocular lesion were diagnosed as perceptual strabismus; optic nerve meningioma and 1 case of lesion in intracranial space sellar sphenoid sinus were diagnosed for retrob-ulbar optic neuritis; 1 case of squamous cell carcinoma of lacrimal sac diagnosed as dacryocystitis; 4 cases of vascular tumor in bone were considered for osteoma by CT scan only with soft tissue window; 2 cases of traumatic intraorbital foreign body missed.The special show of color Doppler ultrasound of extraocular extension of choroidal melanoma was based on the pathological features of choroidal melanoma.Therefore, color Doppler ultrasound examination of eyes should be combined with other imaging examination method and analyzed comprehensively, in order to obtain a correct diagnosis and guide clinical treatment. Conclusions Imaging examination method i

关 键 词：眼眶病 肿瘤 影像学检查 误诊 漏诊 

分 类 号：R512.63[医药卫生—内科学]