克罗恩病初诊误诊分析及防范措施探讨  

Misdiagnosis Analysis and Countermeasures of Crohn's Disease on First Visit

作　　者：徐丽红[1] 韩岩智[1] 王凤美[1] 尚国臣[1] 

机构地区：[1]石河子大学医学院第一附属医院消化内科,新疆维吾尔自治区石河子832008

出　　处：《临床误诊误治》2013年第8期31-34,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析我国近年克罗恩病(crohn's disease,CD)临床初诊误诊现状,并结合国内外防范CD误诊的新进展,探讨适合我国实际情况的防范CD误诊的对策。方法检索、分析2008年1月—2012年1月万方医学数据库和清华同方CNKI数据库发表的有关CD的临床研究及误诊病例报道。评价统计CD的误诊情况、误诊疾病和常用检查及确诊方法。结果共获得可分析文献13篇,累计总CD病例数495例,初诊误诊239例,误诊率48.3%;CD易误诊的疾病是肠道肿瘤、急慢性阑尾炎及阑尾周围病变、溃疡性结肠炎、肠梗阻、肠穿孔、肠结核和肛瘘等;运用最广泛的诊断方法为消化内镜检查结合病理学诊断。结论近年,我国CD的初诊误诊率呈下降趋势,重视CD的特殊临床表现和老年CD的鉴别诊断可更进一步提高CD诊断的准确性,非侵入性标志物的组合运用是进一步减少CD初诊误诊的新方法。Objective To explore appropriate countermeasures with Chinese characteristics in prevention of misdiagnosis of Crohn＇s disease（CD） by analyzing the misdiagnosis actuality on first visit and learning new approaches in prevention of misdiagnosis of CD both at home and abroad.Methods The research and misdiagnosis data of CD during January 2008 and January 2012 from database of Wanfang database and Tsinghua tongfang CNKI database were retrieved and analyzed.The misdiagnosed situation,misdiagnosed diseases,common examinations and confirmed method of CD were statistically evaluated.Results A total of 13 articles were selected including 495 patients with CD,of whom 239 patients were misdiagnosed on first visit with a misdiagnosis rate of 48.3%.Easily misdiagnosed diseases in diagnosis of CD were intestinal tumor,acute and chronic appendicitis,appendiceal ambient lesions,ulcerative colitis,intestinal obstruction,enterobrosis,intestinal tuberculosis and anal fistula;the common diagnosis method was digestive endoscopy examination combined with pathology results.Conclusion In recent years,the misdiagnosis rate of CD has shown a downward trend.The diagnostic accuracy of CD may be further improved by paying attention to special clinical manifestations of CD and differentially diagnosing elderly patient with CD,and the combination application of non-invasive marker is a new way in prevention of CD misdiagnosis.

关 键 词：克罗恩病 误诊 诊断 对策 

分 类 号：R574.62[医药卫生—消化系统]