儿童卵黄囊瘤16例首诊误诊因素分析  

Analysis of Misdiagnosis Factors in 16 Children with Yolk Sac Tumor at First Visit

作　　者：邓巍[1] 曹明为 唐蔚[1] 赖芳芳[1] DENG Wei;CAO Ming-wei;TANG Wei;LAI Fang-fang(Department of Pediatrics,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院儿科,武汉430060

出　　处：《临床误诊误治》2022年第1期9-12,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的总结儿童卵黄囊瘤的临床特点,探究影响误诊的相关因素。方法在2020年9月2日—12月2日以病友QQ群中45例儿童卵黄囊瘤为调查对象,设计调查问卷,收集临床资料,将患儿分为误诊组及未误诊组,分析误诊相关因素。结果首诊误诊率35.56%,误诊组首发症状最多为排便困难,其中11例误诊为其他疾病(便秘3例,急性肾衰竭2例,畸胎瘤2例,积食、腹股沟疝、肾积水、肠道菌群失调各1例),4例医生认为没有问题,1例医生建议继续观察。本组45例中,根据CT/MRI影像学检查联合甲胎蛋白增高确诊16例(35.56%),根据手术切除肿块病理检查确诊15例(33.33%),根据肿块穿刺病理检查确诊11例(24.44%),根据彩色超声发现肿块联合甲胎蛋白增高确诊3例(6.67%)。非省级医院误诊率高于省级医院,原发部位在骶尾部卵黄囊瘤误诊率高于非骶尾部卵黄囊瘤,比较差异有统计学意义(P<0.05)。不同性别、是否有肿块及不同临床分期患儿误诊率比较差异无统计学意义(P>0.05)。结论儿童卵黄囊瘤误诊率较高,应加强基层医师诊断能力和认识水平,重视婴幼儿局部肿块、排便困难的鉴别诊断。影像学检查、血清甲胎蛋白检测可帮助早期明确诊断。Objective To summarize clinical characteristics of paediatric yolk sac tumor and to explore the related factors affecting misdiagnosis.Methods A total of 45 children with yolk sac tumor in the QQ group from September 2,2020 to December 2,2020 were selected as the survey subjects.Questionnaires were designed,and clinical data was collected.The patients were divided into misdiagnosis group and non-misdiagnosis group,and related factors of misdiagnosis were analyzed.Results The misdiagnosed rate at first visit was 35.56%.Difficult defecation was the most common initial symptom in misdiagnosis group.Among them,11 patients were misdiagnosed as having other diseases(3 as having constipation,2 as having acute renal failure,2 as having teratoma,1 as having bound,1 as having inguinal hernia,1 as having hydronephrosis,1 as having alteration of intestinal flora),while 4 patients were thought to be normal,and 1 was recommended to be kept on observation.Among the 45 patients,16 patients(35.56%)were confirmed based on CT/MRI imaging examinations combined with increased AFP;15 patients(33.33%)were confirmed based on pathological examinations of surgical mass removal;11 patients(24.44%)were confirmed according to the puncture biopsy of masses,and 3 patients(6.67%)were confirmed according to the masses detected by color Doppler ultrasound combined with increased AFP.The misdiagnosis rate in non-provincial hospitals was higher than that in provincial hospitals,and the misdiagnosis rate of yolk sac tumor in the sacrococcygeal region was higher than that in non-sacrococcygeal region,and the differences were statistically significant(P<0.05).There were no significant differences in misdiagnosis rates among children with different genders,presence or absence of tumors and different clinical stages(P>0.05)Conclusion The misdiagnosis rate of yolk sac tumor in children is relatively high.The diagnosis ability and understanding of doctors in primary hospitals need to be enhanced,and local lumps and difficult defecation should be paid more

关 键 词：卵黄囊瘤 儿童 误诊 便秘 急性肾衰竭 畸胎瘤 

分 类 号：R737[医药卫生—肿瘤]