胆囊癌误漏诊14例临床分析
Clinical Analysis of 14 Patients with Gallbladder Cancer Misdiagnosed
付明晨 1王丽红 1王福朝 1李新国2
作者信息
- 1. 053000 河北 衡水,衡水市人民医院麻醉科
- 2. 053000 河北 衡水,衡水市人民医院肝胆胰外科
- 折叠
摘要
目的 分析胆囊癌术前误漏诊的原因及防范措施.方法 回顾性分析2020 年1 月—2022 年8 月收治的误漏诊胆囊癌14 例的临床资料.结果 14 例中 4 例有多年胆囊结石史;均有右上腹疼痛不适,恶心呕吐 6 例,食欲缺乏、消瘦11 例,乏力5 例,发热2 例,皮肤、巩膜黄染8 例.14 例均行超声检查,3 例示胆囊单个隆起性圆形或椭圆形强光团且不随体位改变;11 例囊腔体部见多个强回声光团,后方伴有尾影,体位变化时强回声光团会出现相应的位置改变.初步诊断为胆囊结石11 例,胆囊息肉3 例,均行腹腔镜胆囊切除术;11 例胆囊结石者于胆囊体部发现结节状肿物.术后病理检查均提示胆囊乳头状腺癌.误诊时间3～5d.8 例Ⅱ期及3 例Ⅲ期者术后辅以化疗.术后随访2 年,4 例失访,4 例死亡,6 例尚存活.结论 胆囊癌早期症状多样,易合并胆囊良性病变,早期行超声检查特异度不高,导致术前误漏诊率较高.加强对胆囊癌高危因素的认识,熟知其易与其他胆道疾病共存的特点,合理选用检查方法,必要时行病理检查,可降低术前误漏诊率.
Abstract
Objective To analyze the causes and preventive measures of preoperative misdiagnosis or missed diagno-sis of gallbladder cancer.Methods The clinical data of 14 patients with misdiagnosed and missed gallbladder cancer admit-ted from January 2020 to August 2022 were retrospectively analyzed.Results Of the 14 cases,4 had a history of gallstones for many years.There was right upper abdominal pain and discomfort in 14 cases,nausea and vomiting in 6 cases,anorexia and emaciation in 11 cases,fatigue in 5 cases,fever in 2 cases,skin sclera yellow staining in 8 cases.All 14 cases were ex-amined by ultrasound,and 3 cases showed a single raised round or oval strong light mass of gallbladder,which did not change with body position.In 11 cases,there were multiple strong echo light clusters in the lumen of the sac,followed by the posteri-or tail shadow,and the position of the strong echo light cluster would change correspondingly when the body position changed.The preliminary diagnosis was cholecystolithiasis in 11 cases and polyps in 3 cases.All cases underwent laparoscopic cholecys-tectomy.Nodular masses were found in the body of the gallbladder in 11 cases of gallstones.The postoperative pathological ex-amination all indicated papillary adenocarcinoma of the gallbladder.The misdiagnosis lasted 3-5 d.Eight patients with stage Ⅱ and three patients with stage Ⅲ underwent postoperative adjuvant chemotherapy.At 2-year follow-up,4 cases were lost to follow-up,4 cases died and 6 cases survived.Conclusion The early symptoms of gallbladder cancer are varied,and it is of-ten combined with benign gallbladder lesions.The specificity of early ultrasonography is not high,which leads to high preoper-ative misdiagnosis or missed diagnosis rate.Strengthening the understanding of the risk factors of gallbladder cancer,gaining insight into the characteristics of its likelihood to coexist with other biliary diseases,reasonable selection of examination meth-ods and pathological examination when necessary,can reduce the rate of preoperative misdiagnosis.
关键词
胆囊肿瘤/胆囊乳头状腺癌/误诊/漏诊/胆囊息肉/胆结石/胆囊切除术,腹腔镜/病理学检查Key words
Gallbladder neoplasms/Papillary adenocarcinoma of the gallbladder/Misdiagnosis/Missed diagnosis/Gallbladder polyps/Cholelithiasis/Cholecystectomy,laparoscopic/Pathological examination引用本文复制引用
出版年
2023
国家科技期刊平台
NSTL
万方数据