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通过48例大肠癌误诊分析及典型病例的总结,结合复习文献,讨论了大肠癌误诊的原因及对策。提出提高大肠癌诊断的准确率所采取的几点措施:①要详问病史,全面检查,综合分析。对于便血及排便习惯改变的患者,必须提高警惕、详问病史、进行仔细的症状鉴别及全面体格检查、专科检查、最后综合分析、得出结论;②对于有肠道症状的病人,应把直肠指检及乙状结肠镜检查列为常规检查,强调两项检查的重要性,③对便血、大便习惯改变的患者不能轻易诊断为“痔疮”或“肠炎”,应做进一步检查。每个临床医生必须引起注意;④必须熟悉特殊类型大肠癌的临床表现及鉴别诊断;⑤强调钡灌肠造影及肠镜检查对大肠癌诊断的重要性,但也要有“一分为二”的观点,当一次钡灌肠造影或肠镜检查阴性而疑有大肠癌的症状依然存在者,应再次进行气钡双重结肠造影或纤维结肠镜的检查,最好行电子肠镜检查。如果检查都是阴性,仍不能排除大肠癌的诊断,有剖腹探查指征者,应采取积极的办法就是剖腹探查。⑥对活检的重要性必须有足够的认识。一次活检阴性不能完全排除大肠癌的诊断,有时需多次活检方获得正确诊断。
Through the misdiagnosis analysis of 48 cases of colorectal cancer and the summary of typical cases, combined with the review of the literature, the reasons for misdiagnosis of colorectal cancer and the countermeasures were discussed. Several measures taken to improve the accuracy of colorectal cancer diagnosis: 1 to ask the history, a comprehensive inspection, comprehensive analysis. For patients with changes in blood in the stool and bowel habits, we must increase vigilance, detailed medical history, careful diagnosis of symptoms and a comprehensive physical examination, specialist examination, final comprehensive analysis, to draw conclusions; 2 for patients with intestinal symptoms, the rectum should be Indications and sigmoidoscopy are listed as routine examinations, emphasizing the importance of the two examinations. Three patients with altered blood in the stool and bowel habits cannot be easily diagnosed as “acne” or “enteritis” and should be further examined. Each clinician must pay attention; 4 must be familiar with the clinical manifestations and differential diagnosis of specific types of colorectal cancer; 5 emphasize the importance of barium enema angiography and colonoscopy in the diagnosis of colorectal cancer, but also have “one into two” The point of view, when a barium enema or colonoscopy negative and suspected colorectal cancer symptoms still exist, should be double gas stasis double colon or colonoscopy examination, the best line of colonoscopy. If the tests are all negative, the diagnosis of colorectal cancer cannot be ruled out. If there are indications for exploratory laparotomy, a positive approach is the exploratory laparotomy. 6 The importance of biopsy must be adequately understood. A negative biopsy can not completely rule out the diagnosis of colorectal cancer, sometimes requiring multiple biopsies to obtain the correct diagnosis.