[1]韩肖燕,金影,刘伟,等.阑尾周围脓肿误诊为妇科急腹症10例临床分析[J].中国计划生育和妇产科,2017,(11):67-70.
　HAN Xiao-yan,JIN Ying,LIU Wei,et al.Clinical analysis of 10 cases of appendicular abscess misdiagnosed as gynecological acute abdomen[J].Chinese Journal of Family Planning & Gynecotokology,2017,(11):67-70.
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阑尾周围脓肿误诊为妇科急腹症10例临床分析
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2017年11期
页码:
67-70
栏目:
论著与临床
出版日期:
2017-11-25

文章信息/Info

Title:
Clinical analysis of 10 cases of appendicular abscess misdiagnosed as gynecological acute abdomen
作者:
韩肖燕1; 金影1; 刘伟2; 郝增平1*
首都医科大学附属北京友谊医院， 1妇产科;2超声科
Author(s):
HAN Xiao-yan1;  JIN Ying1;  LIU Wei2;  HAO Zeng-ping1*
1.Department of Obstetrics and Gynecology;2.Department of Ultrasound, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing 100050,P.R.China
关键词:
阑尾周围脓肿; 妇科急腹症; 误诊分析; 鉴别诊断
Keywords:
appendicular abscess;  gynecological acute abdomen;  misdiagnose analysis; differential diagnosis
分类号:
R 6568
摘要:
目的探讨阑尾周围脓肿误诊为妇科急腹症的原因及治疗体会，以期提高临床医生鉴别诊断的能力。方法回顾性分析首都医科大学附属北京友谊医院近5年收治的术前考虑妇科急腹症，术中及术后证实为阑尾周围脓肿的10例患者的临床资料，分析临床表现及治疗方法。结果10例患者主要临床表现为发热伴下腹痛，其中4例患者存在腹膜刺激征象，3例伴随消化道症状。10例患者中仅2例出现典型的转移性右下腹痛。妇科查体可扪及附件区压痛的包块。多数患者血白细胞升高，部分患者伴肿瘤标志物糖类抗原125及糖类抗原199轻度升高。10例患者中，术前诊断为卵巢癌破裂继发感染2例，急性盆腔炎2例，右输卵管卵巢脓肿2例，卵巢囊肿2例，卵巢囊肿蒂扭转1例，黄体破裂1例。10例患者中，9例行手术治疗，其中4例行腹腔镜探查+阑尾周围脓肿切除术，3例完整切除阑尾及周围脓肿，1例粘连严重术中仅行阑尾周围脓肿部分切除。2例患者行腹腔镜探查转开腹阑尾切除术，余3例患者行腹腔镜下粘连松解+脓液引流术。结论阑尾周围脓肿是临床常见病，不典型的病例可能与妇科的急腹症相混淆，妇产科临床医生接诊急腹症患者时，需认真做好诊断和鉴别诊断，从而减少或避免阑尾周围脓肿的误诊误治，避免二次手术。
Abstract:
ObjectiveTo explore the reasons and treatment of appendicular abscess misdiagnosed as gynecological acute abdomen and to improve the ability of clinicians to differentiate and diagnose. MethodsRetrospectively analyzed the clinical data of 10 patients in Beijing Friendship Hospital Affiliated to Capital Medical University in the past 5 years who were preoperative considerated gynecological acute abdomen and intraoperative and postoperative confirmed appendicular abscess,to analyze the clinical manifestation and treatment methods. ResultsThe 10 patients were with major clinical manifestations of fever with abdominal pain, of which 4 patients with peritoneal irritation signs, 3 cases with gastrointestinal symptoms. Of the 10 patients, only 2 had typical metastatic right lower abdominal pain. Gynecological examination can found in the attachment area tenderness of the mass. Most patients had elevated white blood cells, some patients with tumor markers CA125 and CA199 slightly elevated.Of the 10 cases, 2 cases were preoperative diagnosed of ovarian cancer rupture secondary infection, 2 cases of acute pelvic inflammatory disease, 2 cases of right oviductal abscess, 2 cases of ovarian cyst, 1 case of ovarian cyst torsion and 1 case of rupture of corpus luteum. Of the 10 patients, 9 were treated surgically, of which 4 cases of laparoscopic exploration + appendiceal abscess resection, 3 cases of complete removal of the appendix and surrounding abscess, only 1 case of partial resection of appendiceal abscess due to serious intraoperative adhesions. 2 patients underwent laparoscopic exploration of open appendectomy. The other 3 patients underwent laparoscopic adhesions release + pus drainage. Conclusion Appendicular abscess is a common clinical disease, atypical cases may be confused with the gynecological acute abdomen. Clinic doctors need to do a good job on diagnosis and differential diagnosis when receiving acute abdomen patients, therefore reducing or avoiding misdiagnosis and secondary surgery.

参考文献/References:

［1］KIM I YMinimally invasive interval appendectomy for perforated appendicitis with a periappendiceal abscess ［J］Annals of Coloproctology, 2016, 32(3): 88–89 ［2］崔满华阑尾周围脓肿误诊为右侧卵巢囊肿扭转5例分析 ［J］. 现代医药卫生，2009，25（1）：109 ［3］杨利忠，安玉松，鲁俊东，等CT扫描在阑尾周围脓肿临床诊断中应用观察 ［J］中国实用医药，2015，10 （7）：72- 73 ［4］赵强，刘承奎，崔庆腹腔镜在阑尾周围脓肿治疗中的应用探讨 ［J］中国现代普通外科进展，2015，18（5）：382, 399

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更新日期/Last Update: 2017-11-25