多排螺旋CT急诊检查结肠病变误诊与漏诊原因分析  

Cause Analysis of the Diagnostic Errors and Missed Diagnosis of Colon Diseases by Multiple Row Helical CT

作　　者：梅友泉 刘秀丽 庞华军 伍强[1] 卓兵芝 赵峰[1] 杨春燕[1] 

机构地区：[1] 新疆石河子市人民医院影像中心,832000 [2] 石河子市纺织医院外妇科

出　　处：《中国全科医学》2015年第17期2078-2082,共5页Chinese General Practice

摘　　要：目的分析多排螺旋CT检查结肠病变误诊与漏诊原因。方法收集2012年9月—2014年10月于石河子市人民医院行急诊结肠多排螺旋CT检查误诊或漏诊的9例患者临床资料,最终均经活检或手术病理明确诊断,分析其误诊或漏诊原因。结果 9例患者中误诊6例,漏诊3例。3例肠痉挛、炎性病变均误诊为结肠癌,经CT复诊行肛管结肠充气后扫描,未见初次CT扫描所见肠内"肿块影",纤维结肠镜检查未见异常组织;1例阑尾黏液囊肿误诊为右侧卵巢囊腺瘤,后经手术病理证实;1例直肠中分化腺癌、1例回盲部溃疡性中分化腺癌误诊为炎性病变。3例漏诊患者经手术病理证实为1例直肠腺癌,1例乙状结肠腺癌及1例升结肠腺癌。结论误诊、漏诊的主要原因是肠道清理及充气准备不佳、对"假肿块"CT征象认识不足。充分的肠道清洁及充气准备,认真区别"假肿块"CT征象,可有效降低结肠病变的误诊、漏诊概率。Objective To analyze the causes of diagnostic errors and missed diagnosis of colon diseases by multiple row helical CT. Methods Clinical data of nine patients,who took emergent colon examination by multiple row helical CT in Shihezi People′s Hospital from September 2012 to October 2014 and were given diagnostic errors and missed diagnosis,were collected. The diagnoses were all reexamined by biopsy and pathology. The causes of diagnostic errors and missed diagnosis were analyzed. Results Among the nine patients, six were diagnosed as wrong disease and three were miss -diagnosed. Three patients who had intestinal spasm and inflammatory lesion were diagnosed as colon cancer. No shadow of ＆quot; intestinal mass＆quot; in the previous CT was found in the subsequent CT with anal canal and colon aeration,and no abnormal structures were found by colonofiberscope examination. One patient with appendiceal mucocele was diagnosed as ovarian cystic adenoma on the right side, which was verified by pathology. One patient with differentiated adenocarcinoma of the rectum and one patient with differentiated adenocarcinoma of the pars caeca anabrosis were diagnosed as inflammatory lesion. Three missed - diagnosed patients were diagnosed as one case of rectal adenocarcinoma,one case of adenocarcinoma of sigmoid flexure and one case of adenocarcinoma of ascending colon. Conclusion The reasons for diagnosis error and missed diagnosis were the inadequate cleaning of intestinal tract and aeration and negligence of recognizing ＆quot; fake mass＆quot; in CT. Adequate cleaning of intestinal tract, fully prepared aeration and earnest attitude in distinguishing ＆quot; fake mass＆quot; in CT could effectively decrease the rate of misdiagnosis and missed diagnosis of colon diseases.

关 键 词：结肠成像 计算机体层摄影 误诊 漏诊 

分 类 号：R814.42[医药卫生—影像医学与核医学] R574.62[医药卫生—放射医学]