摘要
目的分析高位复杂性肛瘘的临床特点、误诊原因及防范措施。方法回顾分析16例误诊为高位复杂性肛瘘的病例资料。结果本组8例(50.00%)以肛周流脓为主要症状,7例(43.75%)以疼痛为主要症状,1例(6.25%)以排便困难为主要症状。8例(50.00%)因反复流脓,指检触及条索状物被误诊为低位单纯性肛瘘;5例(31.25%)因肛旁肿痛,指检触及囊性肿块被误诊为肛周脓肿;2例(12.50%)因坐骨结节附近肿痛被误诊为坐骨结节囊肿伴感染;1例(6.25%)因排便困难,指检直肠触及狭窄环被误诊为直肠狭窄。2例术前确诊为高位复杂性肛瘘,14例术中确诊为高位复杂性肛瘘。确诊后均行手术治疗,术后随访6~12个月,2例复发,3例出现急便感。结论高位复杂性肛瘘临床症状不具有特异性,容易误诊。在临床中应重视病史询问、肛门指检及MRI检查,不断积累经验,降低误诊率。
Objective To analyze the clinical characteristics,causes of misdiagnosis and preventive measures of high complex anal fistula.Methods The clinical data of 16 cases of high complex anal fistula misdiagnosed were analyzed retrospectively.Results The cardinal symptom was fluid pus in 8 cases(50.00%),pain in 7 cases(43.75%)and defecating difficulty in 1 case(6.25%)in the group.All cases underwent digital rectal examinations,including 8 cases(50.00%)misdiagnosed as low simple anal fistula due to flow pus repeatedly and cord on digital rectal examination,5 cases(31.25%)as perianal abscess due to cystic mass on digital rectal examination with swelling and pain,2 cases(12.50%)as cyst of ischial tuberosity with infection due to swelling and pain,and 1 case(6.25%)as rectal stricture due to stricture on digital rectal examination and defecate difficulty.Two cases were diagnosed as high complex anal fistula before surgery,while 14 cases diagnosed during surgery.All cases underwent surgery and were followed up for 6-12 months,in which 2 cases recurred,and 3 cases defecated urgently after operation.Conclusion Given diversity of clinical manifestations and features,high complex anal fistula was more likely to be misdiagnosed initially.Therefore,the present history illness,digital rectal examinations and MRI examination should be performed,and the clinical experience should be accumulated to reduce the rate of misdiagnosis in clinical practice.
作者
陈富军
昝朝元
李杉
李刚
李成书
骆川云
原相军
程英杰
贺平
CHEN FU-jun;ZAN Chao-yuan;LI Shan;LI Gang;LI Cheng-shu;LUO Chuan-yun;YUAN Xiang-jun;CHENG Ying-jie;HE Ping(Department of Coloproctology,Longquan Hospital,West China Hospital of Sichuan University,Chengdu 610100,China;The First Department of Anorectum,Chengdu Anorectum Hospital,Chengdu 610000,China)
出处
《临床误诊误治》
2020年第10期16-19,共4页
Clinical Misdiagnosis & Mistherapy
关键词
直肠瘘
误诊
囊肿
脓肿
直肠狭窄
Rectal fistula
Misdiagnosis
Cysts
Abscess
Rectal stenosis
