56例慢性胆囊炎临床研究.docVIP

56例慢性胆囊炎临床研究[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