【作者】 张伟辉； 薛东波； 段秀庆； 宋春芳； 辛业宏；

【Author】 General surgery department of the 1st affiliated hospital of Harbin medical university ghang Weihui XueDongbo DuanXiuqing SongChunfang 15001 General surgery department of Qiqihaer peace hospital Xin Yehong 161000

【机构】 哈尔滨医科大学第一临床医学院普外科； 齐齐哈尔市和平厂医院普外科；

【摘要】 在临床实践中,有些结肠癌患者有时以急性阑尾炎的表现发病,使结肠癌易被误诊而贻误了结肠癌的最佳治疗时机。本文总结了误诊为急性阑尾炎的结肠癌病例共22例并进行了分析。这22例患者中有3例于术中发现为结肠癌;有19例患者于阑尾切除术后相隔一定时间才发现结肠肿瘤,其中有4例(占21.05％)以发热,右下腹肿块,怀疑阑尾切除术后腹腔内脓肿形成而二次住院;出现粘液血便或黑便的11例(占57.89％);表现为右下腹隐痛、胀痛,右下腹不适的共16例 (占84.21％),发现右下腹肿块的10例(占52.63％);出现贫血、消瘦、乏力的6例(占34.35％)。为尽量避免结肠癌被误诊,对急性阑尾炎患者如存在腹胀,腹部隐痛;或右下腹发现肿块,出现肠梗阻症状;或出现血便、消瘦、贫血等表现时,应警惕结肠肿瘤的存在。如若可疑,可进行直肠指检,便潜血试验,或进一步行钡剂灌肠透视或纤维结肠镜检查以利确诊;手术应采用右下腹探查切口,术中应仔细探查结肠,必要时行术中冰冻病理检查。更多还原

【Abstract】 In clinical practice, some colon carcinoma patients sometimes displayed the clinical features just as acute appendicitis, which lead to misdiagnosis and delay the treatment of colon carcinoma. We collect and analysis 22 cases of colon carcinoma which has been misdiagnosed as acute appen- dicitis. In 3 cases, colon carcinoma were found during operation; in 19 cases, colon carcinoma was found post operation, among them, 4 cases (21.05％) displayed fever complicated with mass in the right lower quadrant of abdomen and was admitted as "abdominal abscessed after appendec- tomy", 11 cases (57,890％) appeared bloody stool and melaena; 16 cases appeared secret anguish, malaise in the right lower quadrant of abdomen; in 10 cases (52,63％) mass was found in the right lower quadrant of abdomen; 6 cases showed anemia, weight—loss, and fatiuged. In order to decrease the incidence of such kind of cases, if a aptent who has been diagnosis as appendicitis but complicated with distention, secret anguish of abdoments or a mass was found in the right lower quadrant of abdomen, or displays intestinal obstruction, or appears bloody stool, weight— loss, anemia, the existence of colon carcinoma should be alerted. Further examination such as rectum examination, stool occult blood test, barium enema or fiber colonoscope should be carried on in order to make a definite diagnosis; The longitudinal incision in right lower quadrant of ab- domen should be chose, and be colon should be surveyed carefully during operation, freeze sec- tion pathologic examination should be prepared if necessary.更多还原