Objective To further understand choledocholithiasis, so as to reduce the misdiagnosis and missed diagnosis in clinical work. Methods The clinical data of 103 patients with choledocholithiasis which were misdiagnosis and missed diagnosis during the course of diseases and diagnosis by endoscopic retrograde cholangiopancreatography in our hospital between August 2005 and July 2010. The clinical features of the patients and treatment were summarized. Results Among 103 patients, 29(37. 2% ) were misdiagnosis stomach disease, 23 (29.5% ) were misdiagnosis acute and chronic hepatitis, 14 were misdiagnosis coronary heart disease and 12 (15. 4% ) were misdiagnosis cold. In patients with both cholecystolithiasis and choledocholithiasis, 25 were missed diagnosis choledocholithiasis. Among 103 patients, 75 (72.8%) were elder than 65 years old. The patients usually presented with fever (n=95, 92.2% ), abdominal pain (n=87, 84.5%), jaundice ( n = 79, 84.5 % ) , nausea and vomiting (n=54, 52.4%). All the patients had abnormal liver function, 98 (95. 1 % ) had leuko-cytosis, and 78(75.7%) had abnormal electrocardiogram. Ultrasonography was the first diagnoses of choledocholithiasis, others were MRCP and CT. Conclusion Examining the patients more carefully and analyzed the abnormal exam can reduce the misdiagnosis and missed diagnosis of choledocholithiasis.%目的 加强对胆总管结石的认识,减少临床误诊及漏诊.方法 回顾性分析2005年8月至2010年7月在我院住院患者中经内镜逆行胰胆管造影(ERCP)确诊胆总管结石,但在诊疗过程中有误诊及漏诊的103例病例,总结其临床特征和诊疗情况.结果103例患者中误诊为胃病者29例(37.2%),误诊为急慢性肝炎者23例(29.5%),误诊为冠心病者14例(17.9%),误诊为感冒者12例(15.4%).胆囊结石合并胆总管结石,漏诊胆总管结石25例.误漏诊患者以年龄大于65岁的老年人居多(75例,72.8%).临床表现以发热最为多见(95例,92.2%),其次为腹痛(87例,84.5%),黄疸(79例,84.5%),恶心、呕吐(54例,52.4%)等.全部病例伴有肝功能异常,外周血白细胞或中性细胞比率升高者98例(95.1%),心电图异常者78例(75.7%).首选诊断方法为超声检查,其次为磁共振胰胆管造影(MRCP)和CT.结论 详细的体检和全面的分析可减少胆总管结石的误诊及漏诊.
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