56例慢性胆囊炎临床分析(1)
[摘要] 目的 探讨慢性胆囊炎的误诊及治疗情况,分析误诊原因,提高诊治水平。方法 对有误诊经历的56例慢性胆囊炎的临床资料进行分析。结果 56例中慢性结石性胆囊炎22例,慢性非结石性胆囊炎34例;误诊为慢性胃炎32例,消化性溃疡12例,病毒性肝炎5例,心绞痛3例,带状疱疹后遗症1例,胃肠神经官能症3例。35例行手术治疗,21例保守治疗,均取得较好效果。结论 有误诊经历的慢性胆囊炎中以误诊为“慢性胃炎”或“消化性溃疡”最多,因此有消化道症状的患者均应早期行腹部B超检查了解胆囊情况,并作胃镜、十二指肠钡餐等排除胃、十二指肠疾病,必要时行胆囊造影,以免误诊误治。治疗仍以手术治疗为主,也可采取保守治疗。
[关键词] 胆囊炎; 误诊
[中图分类号] R576.6+1 [文献标识码] A [文章编号] 1673-9701(2010)15-118-02
Chronic Cholecystitis:Clinical Analysis of 56 Cases
TAN Sutao
Sichuan College of Traditional Chinese Medicine,Mianyang 621000,China
[Abstract] ObjectiveTo discuss the misdiagnosis and treatment of chronic cholecystitis,analyze the cause of misdiagnosis and improve its diagnosis and treatment. MethodsAn analysis was made of the clinical data of 56 cases of misdiagnosis of chronic cholecystitis. ResultsAmong 56 cases,there were 22 cases of chronic calculous cholecystitis and 34 cases of chronic acalculous cholecystitis. And 32 cases were misdiagnosed as chronic gastritis,12 cases as peptic ulcers,5 cases as viral hepatitis,3 cases as cardiac angina,1 case as sequelae of perpes zoster and 3 cases as gastrointestinal neurosis. And surgical therapy was used for 35 cases and conservative therapy for 21 cases,with good treatment effects. ConclusionMost of the misdiagnosis cases of chronic cholecystitis were considered as chronic gastritis or peptic ulcers. Therefore,the patients with gastrointestinal symptoms need to undergo abdominal type-B ultrasound examination in the early period so as to understand the situation of the gallbladder,and meanwhile the examination of gastroscope or hypotonic duodenal barium will be added to exclude gastric or duodenal diseases. Gallbladder imaging is carried out when necessary to avoid misdiagnosis. The main treatment is surgery and conservative treatment is secondary.
[Key words]Cholecystitis; Misdiagnosis
慢性胆囊炎包括结石性和非结石性胆囊炎,均是胆囊的慢性炎症。临床表现可为典型的胆系症状如右上腹绞痛、阵发性加重,痛时伴有放射到右肩或背心,也可表现为“慢性胃炎”的症状,如上腹隐痛、腹胀、冒酸、嗳气等,临床上被误诊时有发生,得不到及时正确的治疗。近年来由于B超检查的广泛普及和患者对自身健康的重视,慢性胆囊炎的诊断日益增多。我院2006年~ 2009年门诊及住院共收治有误诊经历的慢性胆囊炎患者56例,现结合文献对其误诊情况进行分析。
1 临床资料
1.1 一般资料
本组56例,男性26例,女性30例。年龄最大79岁,最小10岁,平均41岁。其中慢性结石性胆囊炎22例,慢性非结石性胆囊炎34例。误诊时间最长20年,最短15d。
1.2 误诊疾病
误诊的疾病:慢性胃炎32例,消化性溃疡12例,病毒性肝炎5例,心绞痛3例,带状疱疹后遗症1例,胃肠神经官能症3例。
本组临床表现无特异性,均有反复发作史,多有餐后饱胀、上腹隐痛、厌油腻等胃肠疾病的症状。误诊为慢性胃炎的32例,主要表现为反复发作的上腹饱胀、隐痛、恶心、反酸、嗳气等,给予对症处理后症状可消失;有20例作胃镜示慢性浅表性或胆汁返流性或萎缩性胃炎,未再进一步检查,其中1例10岁女孩,表现为上腹胀痛伴恶心,进食后加重,按照胃炎治疗无效,胃镜发现胆汁反流明显,作腹部B超诊为慢性胆囊炎,经消炎利胆治疗后缓解;误诊为消化性溃疡的12例,临床表现为反复上腹疼痛、有餐后加剧或夜间发作的规律性,与消化性溃疡极其相似,但给予抗溃疡治疗效果不佳,有3例作胃镜提示十二指肠球部溃疡,经标准抗溃疡治疗后复查胃镜溃疡愈合,但病人上述症状仍反复,后作腹部彩超证实为胆囊多发性结石并胆囊炎,手术后症状完全消失;误诊为病毒性肝炎的5例,均有“乙肝”病毒携带,表现为乏力、纳差、厌油、肝区不适、胆红素及ALT升高;误诊为心绞痛的3例,表现为突发心前区及剑下闷痛或绞痛,伴恶心、呕吐、心率增快,心电图见V3～V6 ST段压低,T波低平,给予硝酸甘油含服无效,持续时间几分钟至几十分钟不等,多数时候自行缓解,后经B超证实为巨大胆囊伴结石;误诊为带状疱疹后遗症者1例,因有右上腹壁带状疱疹史,之后反复出现右上腹痛,伴右肩背部放射痛,予止痛治疗可暂时缓解,后作B超、胃镜等检查诊断为胆囊结石,予手术治疗后未再发病。误诊胃肠神经官能症3例,患者有消化道不适并伴有长期的焦虑、失眠等症状,加之病人拒绝检查,给予抗焦虑治疗无效,后作B超、胃镜等确诊,经消炎利胆治疗症状消失。
2 结果
56例病人中22例为胆囊结石伴炎症,34例为非结石性慢性胆囊炎。有35例行手术治疗,其中24例作腹腔镜,11例作开腹手术,开腹手术者均为结石性胆囊炎,取得了满意的效果,随访2年未再有症状发作;21例通过饮食调节和中西医保守治疗,症状明显减轻,不影响正常生活。, 百拇医药(谭素涛)
[关键词] 胆囊炎; 误诊
[中图分类号] R576.6+1 [文献标识码] A [文章编号] 1673-9701(2010)15-118-02
Chronic Cholecystitis:Clinical Analysis of 56 Cases
TAN Sutao
Sichuan College of Traditional Chinese Medicine,Mianyang 621000,China
[Abstract] ObjectiveTo discuss the misdiagnosis and treatment of chronic cholecystitis,analyze the cause of misdiagnosis and improve its diagnosis and treatment. MethodsAn analysis was made of the clinical data of 56 cases of misdiagnosis of chronic cholecystitis. ResultsAmong 56 cases,there were 22 cases of chronic calculous cholecystitis and 34 cases of chronic acalculous cholecystitis. And 32 cases were misdiagnosed as chronic gastritis,12 cases as peptic ulcers,5 cases as viral hepatitis,3 cases as cardiac angina,1 case as sequelae of perpes zoster and 3 cases as gastrointestinal neurosis. And surgical therapy was used for 35 cases and conservative therapy for 21 cases,with good treatment effects. ConclusionMost of the misdiagnosis cases of chronic cholecystitis were considered as chronic gastritis or peptic ulcers. Therefore,the patients with gastrointestinal symptoms need to undergo abdominal type-B ultrasound examination in the early period so as to understand the situation of the gallbladder,and meanwhile the examination of gastroscope or hypotonic duodenal barium will be added to exclude gastric or duodenal diseases. Gallbladder imaging is carried out when necessary to avoid misdiagnosis. The main treatment is surgery and conservative treatment is secondary.
[Key words]Cholecystitis; Misdiagnosis
慢性胆囊炎包括结石性和非结石性胆囊炎,均是胆囊的慢性炎症。临床表现可为典型的胆系症状如右上腹绞痛、阵发性加重,痛时伴有放射到右肩或背心,也可表现为“慢性胃炎”的症状,如上腹隐痛、腹胀、冒酸、嗳气等,临床上被误诊时有发生,得不到及时正确的治疗。近年来由于B超检查的广泛普及和患者对自身健康的重视,慢性胆囊炎的诊断日益增多。我院2006年~ 2009年门诊及住院共收治有误诊经历的慢性胆囊炎患者56例,现结合文献对其误诊情况进行分析。
1 临床资料
1.1 一般资料
本组56例,男性26例,女性30例。年龄最大79岁,最小10岁,平均41岁。其中慢性结石性胆囊炎22例,慢性非结石性胆囊炎34例。误诊时间最长20年,最短15d。
1.2 误诊疾病
误诊的疾病:慢性胃炎32例,消化性溃疡12例,病毒性肝炎5例,心绞痛3例,带状疱疹后遗症1例,胃肠神经官能症3例。
本组临床表现无特异性,均有反复发作史,多有餐后饱胀、上腹隐痛、厌油腻等胃肠疾病的症状。误诊为慢性胃炎的32例,主要表现为反复发作的上腹饱胀、隐痛、恶心、反酸、嗳气等,给予对症处理后症状可消失;有20例作胃镜示慢性浅表性或胆汁返流性或萎缩性胃炎,未再进一步检查,其中1例10岁女孩,表现为上腹胀痛伴恶心,进食后加重,按照胃炎治疗无效,胃镜发现胆汁反流明显,作腹部B超诊为慢性胆囊炎,经消炎利胆治疗后缓解;误诊为消化性溃疡的12例,临床表现为反复上腹疼痛、有餐后加剧或夜间发作的规律性,与消化性溃疡极其相似,但给予抗溃疡治疗效果不佳,有3例作胃镜提示十二指肠球部溃疡,经标准抗溃疡治疗后复查胃镜溃疡愈合,但病人上述症状仍反复,后作腹部彩超证实为胆囊多发性结石并胆囊炎,手术后症状完全消失;误诊为病毒性肝炎的5例,均有“乙肝”病毒携带,表现为乏力、纳差、厌油、肝区不适、胆红素及ALT升高;误诊为心绞痛的3例,表现为突发心前区及剑下闷痛或绞痛,伴恶心、呕吐、心率增快,心电图见V3～V6 ST段压低,T波低平,给予硝酸甘油含服无效,持续时间几分钟至几十分钟不等,多数时候自行缓解,后经B超证实为巨大胆囊伴结石;误诊为带状疱疹后遗症者1例,因有右上腹壁带状疱疹史,之后反复出现右上腹痛,伴右肩背部放射痛,予止痛治疗可暂时缓解,后作B超、胃镜等检查诊断为胆囊结石,予手术治疗后未再发病。误诊胃肠神经官能症3例,患者有消化道不适并伴有长期的焦虑、失眠等症状,加之病人拒绝检查,给予抗焦虑治疗无效,后作B超、胃镜等确诊,经消炎利胆治疗症状消失。
2 结果
56例病人中22例为胆囊结石伴炎症,34例为非结石性慢性胆囊炎。有35例行手术治疗,其中24例作腹腔镜,11例作开腹手术,开腹手术者均为结石性胆囊炎,取得了满意的效果,随访2年未再有症状发作;21例通过饮食调节和中西医保守治疗,症状明显减轻,不影响正常生活。, 百拇医药(谭素涛)