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3~5 d。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。
Objective To analyze the causes and preventive measures of preoperative misdiagnosis or missed diagnosis of gallbladder cancer.Methods The clinical data of 14 patients with misdiagnosed and missed gallbladder cancer admitted 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 examined 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 posterior 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 cholecystectomy.Nodular masses were found in the body of the gallbladder in 11 cases of gallstones.The postoperative pathological examination all indicated papillary adenocarcinoma of the gallbladder.The misdiagnosis lasted 3-5 d.Eight patients with stageⅡand three patients with stageⅢunderwent 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 often combined with benign gallbladder lesions.The specificity of early ultrasonography is not high,which leads to high preoperative 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 methods and pathological examination when necessary,can reduce the rate of preoperative misdiagnosis.
作者
付明晨
王丽红
王福朝
李新国
FU Mingchen;WANG Lihong;WANG Fuchao;LI Xinguo(Department of Anesthesiology,People's Hospital of Hengshui City,Hengshui,Hebei 053000,China;Department of Hepatobiliary and Pancreatic Surgery,People's Hospital of Hengshui City,Hengshui,Hebei 053000,China)
出处
《临床误诊误治》
CAS
2023年第9期18-21,共4页
Clinical Misdiagnosis & Mistherapy
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
Gallbladder neoplasms
Papillary adenocarcinoma of the gallbladder
Misdiagnosis
Missed diagnosis
Gallbladder polyps
Cholelithiasis
Cholecystectomy,laparoscopic
Pathological examination
