妊娠并结肠肿瘤误诊为腹壁下血肿病例分析  

Analysis of Gestation Complicated with Colonic Neoplasms Misdiagnosed as Hematoma Under Abdominal Wall

作　　者：黄百灵[1] 王婷婷[1] 冯桂萍[1] 周瑾[1] 

机构地区：[1]兰州军区乌鲁木齐总医院妇产科,乌鲁木齐830000

出　　处：《临床误诊误治》2014年第6期26-28,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨妊娠合并结肠肿瘤的误诊原因并提出预防措施。方法对1例误诊为腹壁下血肿的妊娠合并结肠肿瘤的临床资料进行回顾性分析。结果本例因停经28+2周、持续下腹痛伴阴道少量流血2 h入院,经妇科查体、血常规及B超等检查诊断为子痫前期(重度)、胎盘早剥、贫血(重度)。为挽救患者生命,急诊行剖宫产,术后对症治疗期间,患者出现左中腹疼痛,考虑腹壁下血肿、完全性肠梗阻,再次剖腹探查,术中见乙状结肠中段可触及15 cm×8 cm×4 cm大小的包块,术后病理诊断为(结肠)浆膜梭形细胞瘤。待患者病情平稳后转入普外科继续治疗。结论临床表现不典型、诊断思维局限及缺乏诊断经验是造成妊娠合并结肠肿瘤误诊的主要原因。Objective To explore misdiagnosis causes of gestation complicated with colonic neoplasms and to provide preventive measures. Methods Clinical data of one patient with gestation complicated with colonic neoplasms misdiagnosed as having hematoma under abdominal wall was retrospectively analyzed. Results The patient was admitted for suppressed menstruation for 28＋ 2weeks and continuous hypogastralgia with a small amount of vagina bleeding for 2 h. The diagnosis of pre-eclampsia（ severe）,placental abruption and anemia（ severe） was given after gynecological examination,routine blood test and ultrasonography. The emergency cesarean delivery operation was performed to save the patient＇s life,but the patient had the left midabdomen pain during postoperative corresponding treatment,and then hematoma under abdominal wall and complete intestinal obstruction were suspected. A 15 cm × 8 cm × 4 cm lump in the middle of sigmoid colon was found during the exploratory laparotomy,and the serous spindle cell tumor of colon was confirmed by postoperative pathologic diagnosis.The patient was transferred to general surgery department for continous treatment after the condition became stable. Conclusion The main misdiagnosis causes of gestation complicated with colonic neoplasms are uncharacteristic clinical symptoms,limited diagnosis thinking and lack of clinical experience.

关 键 词：妊娠并发症 结肠肿瘤 误诊 腹壁下血肿 

分 类 号：R735.35[医药卫生—肿瘤]