摘要
目的探讨剥脱性食管炎的临床特点、误诊原因及其防范措施。方法回顾性分析1998年2月—2014年6月我院收治的60例剥脱性食管炎中14例误诊病例的临床资料。结果本组均以胸骨后或剑突下疼痛为主要症状,伴咽下疼痛及吞咽困难9例,恶心、呕吐6例,黑便4例。本组误诊率23.3%,误诊时间4 h^5 d。9例于外院首诊误诊,5例于我院首诊误诊,误诊为急性心肌梗死4例,食管肿物及反流性食管炎各3例,心绞痛及主动脉夹层各2例。按误诊疾病予相应治疗效果不佳,经电子胃镜检查确诊为剥脱性食管炎,给予相应治疗7~15 d临床症状消失。3个月后复查胃镜示食管黏膜创面愈合。结论临床遇及以突发胸骨后或剑突下疼痛为主要症状的患者时,应注意其是否伴消化道症状,考虑到剥脱性食管炎可能,胸部CT检查可为其提供间接指征,电子胃镜检查是其确诊手段。
Objective To analyze the clinical features, misdiagnosis causes and precautionary measures of exfolia-tive esophagitis. Methods Clinical data of 14 patients out of 60 patients misdiagnosed with exfoliative esophagitis during February 1998 and June 2014 in our hospital was retrospectively analyzed. Results The main symptoms of the group was retrosternal or xiphoid pain, with swallowing pain and dysphagia in 9 cases, nausea and vomiting in 6 cases, melena in 4 ca-ses. The misdiagnosis rate was 23. 3% and the misdiagnosed time was from 4 h to 5 d. 9 patients were misdiagnosed in other hospitals, and 5 patients were misdiagnosed in our hospital. 4 patients were misdiagnosed with myocardial infarction, 3 were misdiagnosed with reflux esophagitis, 3 were misdiagnosed with tumors of esophagus, 2 were misdiagnosed with angina pecto-ris, and 2 were misdiagnosed with aortic dissection. The treatment as misdiagnosed conditions was ineffective. The 14 patients were diagnosed as having exfoliative esophagitis under electronic gastroscope. After a 7-15 d conventional therapy, clinical symptoms of the 14 patients subsided. Esophageal mucosa wound healing was observed under endoscopy 3 months later. Con-clusion If the patient with retrosternal pain or xiphoid pain as the main symptoms, clinicians should pay attention to the di-gestive tract symptoms and take exfoliative esophagitis into account. Chest CT examination can provide indirect indications. E-lectronic gastroscopy is the best way to confirm diagnosis.
出处
《临床误诊误治》
2015年第5期23-25,共3页
Clinical Misdiagnosis & Mistherapy
关键词
食管炎
误诊
心肌梗死
食管肿瘤
冠心病
Esophagitis
Diagnostic error
Myocardial infarction
Esophageal neoplasm
Coronary disease
