以消化道症状为主要表现的其他疾病误诊为儿童炎症性肠病原因分析  

Analysis of the Causes of Misdiagnosis of Other Diseases with the Main Manifestation of Gastrointestinal Symptoms as Inflammatory Bowel Disease in Children

作　　者：王健[1] 徐樨巍 WANG Jian;XU Xiwei(Department of Pediatrics,School of Clinical Medicine of Tsinghua University,Beijing Tsinghua Changgung Hospital,Beijing 102218,China)

机构地区：[1]清华大学临床医学院、清华大学附属北京清华长庚医院儿科,北京102218

出　　处：《临床误诊误治》2023年第12期23-26,47,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨以消化道症状为主要表现的其他疾病误诊为儿童炎症性肠病的原因,并总结防范措施。方法回顾分析2021年4月—2023年4月收治的3例误诊为儿童炎症性肠病的临床资料。结果2例以腹泻、便血为主要表现,1例以腹痛为主要表现,初诊均诊断为儿童炎症性肠病,误诊时间2~8个月。入我院后经详细询问病史、严格查体并结合相关医技检查,3例分别诊断为慢性肉芽肿病、阿米巴肠炎、淋巴瘤。慢性肉芽肿病患儿放弃治疗死亡,阿米巴肠炎患儿予甲硝唑治疗痊愈,淋巴瘤患儿予规律化疗生存良好。结论为避免其他以消化道症状为主要表现的疾病误诊为儿童炎症性肠病,临床医师应熟练掌握儿童炎症性肠病的诊断及鉴别诊断要点,详细询问病史,尽早完善相关检查,提高诊断准确率,避免误诊。Objective To investigate the causes of misdiagnosis of other diseases mainly characterized by gastrointestinal symptoms as inflammatory bowel disease(IBD)in children,and to summarize preventive measures.Methods The clinical data of three children misdiagnosed as IBD from April 2021 to April 2023 were retrospectively analyzed.Results Diarrhea and hematochezia were the main manifestations in 2 patients,and abdominal pain was the main manifestation in 1 patient.All children were diagnosed as pediactric IBD at initial diagnosis,and the duration of misdiagnosis was 2 to 8 months.According to detailed medical history,rigorous physical examination and relevant medical examination after admission to our hospital,3 patients were diagnosed as chronic granulomatosis,amebic enteritis and lymphoma,respectively.The child with chronic granulomatosis died after giving up treatment,the child with amebic enteritis were cured by metronidazole treatment,and the child with lymphoma survived well after regular chemotherapy.Conclusion In order to avoid misdiagnosis of other diseases mainly characterized by gastrointestinal symptoms as pediatric IBD,clinicians should be proficient in the diagnosis and differential diagnosis of pediatric IBD,inquire about the history in detail,improve relevant examinations as soon as possible,and improve the diagnostic accuracy,to avoid misdiagnosis.

关 键 词：阿米巴肠炎 淋巴瘤 肉芽肿病 慢性 误诊 炎症性肠病 腹泻 便血 腹痛 

分 类 号：R733[医药卫生—肿瘤] R730.263[医药卫生—临床医学]