女性腹部结核病——一种容易误诊为晚期卵巢癌的疾病(附45例临床分析)  

Clinical Analysis of 45 Cases of Female Tuberculous Peritonitis Mimicking Advanced Ovarian Cancinoma

作　　者：石宇[1] 谢瑞梦[1] 宋水勤[1] 徐世强[1] 樊英[1] 张国楠[1] 

机构地区：[1]四川省肿瘤医院妇瘤科,成都610041

出　　处：《肿瘤预防与治疗》2011年第6期319-321,共3页Journal of Cancer Control And Treatment

摘　　要：目的:通过分析女性腹部结核病的临床特征,探讨其容易误诊为卵巢癌的原因。方法:回顾性分析45例女性腹部结核病患者的临床表现特征、诊断和治疗结果。结果:腹胀、腹水、盆腔包块"三联征"是女性腹部结核病患者的主临床特征;45例女性腹部结核病中,术前误诊为卵巢癌13例,术前明确诊断3例,血清CA125值升高38例(平均值为410.1u/ml);17例行腹盆腔CT检查,其中3例诊断盆腹腔结核病,14例诊断盆腹腔占位病变,提示卵巢肿瘤可能性大。经手术明确诊断42例;患侧附件切除9例,患侧输卵管切除11例,脓肿引流6例,结核病灶清除1例,病变活检15例。全部患者接受了抗结核治疗。结论:本文报道的女性腹部结核病的临床表现与体征和卵巢癌极为相似,临床易误诊为卵巢癌,术前CT检查有一定的诊断价值,而肿瘤标记物血清CA125值无诊断与鉴别诊断意义;手术可以明确诊断与清除结核病灶,缩短药物治疗时期,有利于结核病的痊愈。Objective： To analyze the clinical features of tuberculous peritonitis and to explore the reason why it tends to be misdiagnosed as ovarian cancer. Methods： Clinical manifestation, diagnosis, and treatment results of 45 cases of tuberculous peritonitis were reviewed retrospectively. Results： The main clinical features included abdominal distention, ascites, and pelvic mass. Thirteen cases were misdiagnosed as ovarian cancer preoperatively and 3 cases got the correct diagnosis before operation. The serum CA 125 levels （ mean value 410. lu/ml） elevated in 38 cases . Seventeen cases accepted CT examination for the abdomen and pelvis. Three of them were diagnosed as abdominal and pelvic tuberculosis, and 14 were diagnosed as space occupying lesion with high possibility of ovarian cancer. Forty-two cases were confirmed diagnosis after operation. Surgical approach included 9 cases of affected lateral adnexectomy, 11 affected lateral salpingeetomy,6 abscess drainage, 1 clearance of tuberculous lesion and 15 biopsy. All patients received antituberculosis therapy after operation. Conclusion： The clinical manifestations of tuberculous peritoneal are extremely similar to that of ovarian cancer, which result in misdiagnosis in clinical practice. Surgery is a good way to distinguish tuberculous peritonitis and ovarian cancer and get final diagnosis, as well as to remove tuberculous lesion with short medicine regimen and help to improve recovery of patients.

关 键 词：结核性腹膜炎 诊断 治疗 

分 类 号：R526[医药卫生—内科学] R527.4[医药卫生—临床医学]