摘要
目的探讨贲门癌的临床特点、误诊原因及防范误诊措施。方法回顾性分析2019年2月—2021年10月收治病初误诊的10例贲门癌临床资料。结果本组早期出现中上腹胀疼痛5例,胃烧灼感6例,食欲缺乏5例,间歇性吞咽不适不畅4例,胸骨后隐痛4例,恶心呕吐4例,咽喉干燥、有异物感4例,黑便2例,贫血2例,胸骨区疼痛不适1例,心悸及心前区不适1例;后期均有不同程度吞咽困难、胸骨后阻挡感、呕吐、贫血消瘦明显。9例就诊初期未行X线上消化道造影、胃镜病理检查,初步考虑为慢性胃炎4例、慢性食管炎4例、消化性胃溃疡1例;1例因消化系统外症状明显加之平板运动试验阳性,Holter提示心肌缺血性改变,初步考虑为冠心病。10例按误诊疾病予相应治疗后,症状无好转甚或加重,加行X线上消化道造影和(或)胃镜病理检查确诊为贲门癌。误诊时间为2~7个月。1例误诊为冠心病者因病变范围广且发生转移而未行手术治疗,予放射治疗;余9例行根治性手术切除治疗,术后予表柔比星+顺铂+5-氟尿嘧啶标准化疗。术后患者症状明显缓解,随访6个月均存活。结论贲门癌以中老年人多见,初期症状体征无特异性,易与常见慢性消化系统疾病等混淆;加强对本病的认识,提高对本病的警惕性,全面分析病情,仔细询问病史,重视并及时行X线上消化道造影、胃镜病理检查,有助于本病的正确诊断。
Objective To explore the clinical characteristics,causes of misdiagnosis and preventive measures of cardia cancer.Methods Clinical data of 10 patients with cardia cancer initially misdiagnosed from February 2019 to October 2021 were retrospectively analyzed.Results In this group,there were 5 cases of early middle and upper abdominal distension and pain,6 cases of burning,5 cases of lack of appetite,4 cases of intermittent swallowing discomfort,4 cases of retrosternal pain,4 cases of nausea and vomiting,4 cases of dry throat and foreign body sensation,2 cases of black stool,2 cases of anemia,1 case of pain and discomfort in the sternal region,1 case of palpitation and discomfort in the precardiac region.In the later stage,there were different degrees of dysphagia,posterior sternal block,vomiting,anemia and emaciation.The 9 cases did not receive X-ray gastrointestinal angiography and gastroscopy and pathological examination at the initial stage of treatment,and were preliminarily considered as chronic gastritis in 4 cases,chronic esophagitis in 4 cases and peptic gastric ulcer in 1 case.Due to obvious extra-digestive symptoms and positive treadmill exercise test,Holter indicated myocardial ischemic changes in 1 case,which was preliminarily considered as coronary heart disease(CHD).The symptoms of ten cases were not improved or even aggravated after treatment according to the misdiagnosed disease,and they were diagnosed as gastric cardia cancer by X-ray gastrointestinal angiography and/or gastroscopy pathology.Misdiagnosis lasted from 2 to 7 months.One case was misdiagnosed as CHD due to the wide range of lesions and metastases and did not receive surgical treatment,and received radiotherapy.The remaining 9 patients underwent radical surgical resection and received epirubicin+cisplatin+5-fluorouracil standard chemotherapy.Postoperative symptoms were significantly relieved,and all patients survived at 6 months of follow-up.Conclusion Cardia cancer is common in middle-aged and elderly people,and the early symptoms and
作者
杜海宽
白利君
刘荣新
陈浩
杨波
于超
DU Hai-kuan;BAI Li-jun;LIU Rong-xin;CHEN Hao;YANG Bo;YU Chao(The Second Department of General Surgery,Military Industrial Hospital of Qinhuangdao City,Qinhuangdao,Hebei 066500,China;Department of Oncology,Military Industrial Hospital of Qinhuangdao City,Qinhuangdao,Hebei 066500,China;Department of Urologic Surgery,Military Industrial Hospital of Qinhuangdao City,Qinhuangdao,Hebei 066500,China;the First Department of General Surgery,Military Industrial Hospital of Qinhuangdao City,Qinhuangdao,Hebei 066500,China;Department of Imaging,Military Industrial Hospital of Qinhuangdao City,Qinhuangdao,Hebei 066500,China)
出处
《临床误诊误治》
CAS
2022年第12期1-4,共4页
Clinical Misdiagnosis & Mistherapy
基金
2019年秦皇岛市市级科技计划自筹项目(201902A138)。
关键词
贲门肿瘤
误诊
慢性胃炎
消化性胃溃疡
慢性食管炎
冠心病
Cardia neoplasms
Misdiagnosis
Chronic gastritis
Peptic gastric ulcer
Chronic esophagitis
Coronary heart disease
