脊柱源性腹痛误诊患者的临床特点分析  

Clinical Analysis of Misdiagnosed Spine Derived Abdominal Pains

作　　者：袁晓艳[1,2] 汤浩[3] 姜敏[1] 

机构地区：[1]中国医科大学附属第一医院消化内科,辽宁省沈阳市110001 [2]本钢总医院消化内科,辽宁省本溪市 [3]沈翔705医院内科,辽宁省沈阳市

出　　处：《中国全科医学》2013年第17期2025-2027,共3页Chinese General Practice

摘　　要：目的分析国内报道的脊柱源性腹痛误诊患者的临床资料,加深临床医生对该病的重视。方法以"脊柱源性腹痛、误诊"为主题词,通过中国医科大学图书馆,检索维普网络数据库、万方网络数据库、中国知网网络数据库、中国生物医学文献数据库2000—2011年公开发表的国内病例报道。结果最终纳入51例患者,男29例,女22例;年龄13～89岁,平均53岁。最初误诊疾病:急性阑尾炎9例、腹痛待查5例,泌尿系统结石5例、慢性胆囊炎4例、胃肠炎3例、附件炎3例、慢性阑尾炎2例、腹部空腔脏器穿孔2例、肠痉挛2例、胰腺炎2例、不全肠梗阻2例、胃食管反流病2例、盆腔炎2例、阑尾残株炎1例、慢性胃炎1例、消化性溃疡1例、肠易激综合征1例、胃肠神经官能症1例,冠心病心绞痛1例、前列腺炎1例、慢性腰背肌筋膜炎1例。所有患者针对误诊病因及对症治疗,消化道症状多数改善,但腹痛不能缓解。重新全面体检后根据阳性发现进一步完善脊柱X线片或CT、磁共振成像(MRI)检查后确诊,确诊后针对病因治疗,所有患者腹痛得到缓解。结论详细询问病史和全面体格检查是避免脊柱源性腹痛误诊的关键,进一步结合脊柱影像学检查则有利于确诊。Objective To analyze the clinical data of patients with misdiagnosed spine derived abdominal pains in do-mestic reports, to deepen clinicians＇ attention to it. Methods Taking ＂ spine derived abdominal pains, misdiagnosis＂ as key words, domestic case reports from 2000 to 2011 were retrieved in Weipu network database, Wanfang network database, CNKI network database, CBM network database. Results Finally 51 patients were enroUed, including 29 males and 22 females, aged at 13 to 89 years old, averaging at 53 years old. The patients were misdiagnosed initially as acute appendicitis （n = 9 ）, abdominal pain （ n = 5 ）, urinary tract stones （ n = 5 ）, chronic cholecystitis （ n = 4 ）, gastroenteritis （ n = 3 ）, appendagitis （ n = 3）, chronic appendicitis （ n = 2）, rupture of hollow viscus （ n = 2）, enterospasm （ n = 2）, pancreatitis （ n = 2）, in- complete intestinal obstruction （ n = 2 ） , gastroesophageal reflux disease （ n = 2 ） , pelvic inflammation （ n = 2 ） , appendix stump inflammation （ n = 1 ） , chronic gastritis （ n = 1 ） , peptic ulcer （ n = 1 ） , irritable bowel syndrome （ n = 1 ）, gastroin testinal neurosis （ n = 1 ） coronary disease and angina （ n = 1 ） , prostatitiis （ n = 1 ） , chronic low hack myofascitis （ n = 1 ）. All patients were given symptomatic treatments aimed at misdiagnosis etiology, and most gastrointestinal symptoms alleviated, but abdominal pains did not. After full re - examination, spine derived abdominal pains were confirmed by further spine X - ray or CT, MRI. Treatment aimed at etiology alleviated abdominal pains in all patients. Conclusion Detailed inquiry of patients＇ his-tory, a thorough physical examination are the key to avoid spine derived abdominal pain misdiagnosed, it will he helpful for diag-nosis if further combined with spinal imaging examination.

关 键 词：腹痛 误诊 体征和症状 

分 类 号：R256.33[医药卫生—中医内科学]