标题：膈下游离气体误诊为胃肠道穿孔六例临床分析

      作者：田茂金，太云翔
    （凉山州第一人民医院外五科，四川 西昌 615000）

      卷次： 2014年25卷3期

      【摘要】 目的 探讨临床膈下游离气体误诊胃肠道穿孔的原因，提高诊断符合率。方法 对我院6例腹部
立位X平片提示膈下游离气体，临床诊断为胃肠道穿孔经急诊剖腹探查为误诊患者的临床资料进行回顾性分
析。结果 6例患者均痊愈出院，其中2例切口感染，1例左胸腔少量积液，无其他并发症。结论 膈下游离气体
并非胃肠道穿孔所特有的影像表现，关键在于提高膈下游离气体的病因诊断和鉴别诊断水平，既可避免不必要
的误诊，又能为治疗提供较好的指引。

      【关键词】 膈下游离气体；误诊；消化道穿孔；病因

      【中图分类号】 R656.6 【文献标识码】 A 【文章编号】 1003—6350（2014）03—0403—02


Free gas under the diaphragm in the misdiagnosis of gastrointestinal tract perforation (clinical analysis of six
cases).
TIAN Mao-jin, TAI Yun-xiang. The Frist Hospital of Liangshan Autonomous Region, Xichang 615000, Sichuan,
CHINA

【Abstract】 Objective To explore the clinical free gas under diaphragm misdiagnosed the causes of gastroin-
testinal perforation, improve the diagnostic coincidence rate. Methods In our 6 cases abdominal stand X-ray plain
film tip free gas under diaphragm, clinical diagnosis of gastrointestinal perforation after emergency laparotomy for
misdiagnosis in patients with clinical data were retrospectively analyzed. Results Six patients with the free gas un-
der diaphragm were detected no perforation of gastrointestinal tract by surgery, and exploration revealed liver abscess
rupture in 3 cases, 1 cases of gangrenous cholecystitis with perforation, 1 cases of primary peritonitis, 1 cases of hepat-
ic flexure of the colon elevated significantly by adhesive intestinal obstruction caused. After found the misdiagnosis,
according to different situation during the operation, take appropriate surgical procedure. 6 patients were cured and dis-
charged. Conclusion Free gas under diaphragm is not peculiar to the gastrointestinal tract perforation image perfor-
mance. It's the key to improve the cause of free gas under diaphragm diagnosis and differential diagnosis level, which
can avoid unnecessary misdiagnosis and provide better guidance for treatment.