腹膜假黏液瘤12例临床误诊分析  

Misdiagnosis Analysis of 12 Patients with Pseudomyxoma Peritonei

作　　者：李文忠 潘妍[2] 刘佳[2] 徐立[2] 王新[2] LI Wen-zhong PAN Yan LIU Jia XU Li WANG Xin(Department of Gastroenterology, Changhn Hospital, Xi＇an 710016, China Department of Gastroenterology, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, Xi＇an 710032, China)

机构地区：[1]长安医院消化内科,西安710016 [2]第四军医大学西京消化病医院消化内科,西安710032

出　　处：《临床误诊误治》2017年第1期18-20,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨腹膜假黏液瘤(pseudomyxoma peritonei,PMP)的临床特点及误诊原因。方法回顾性分析第四军医大学西京消化病医院2011年3月—2015年3月收治的12例PMP误诊病例资料。结果 12例主要表现为进行性腹胀,腹部CT、超声检查提示腹腔积液,部分患者结核抗体及肿瘤标志物阳性,首诊误诊为腹腔恶性肿瘤性质待查4例,肝硬化腹腔积液3例,卵巢肿瘤、结核性腹膜炎各2例,腹膜转移瘤可能1例。其中消化内科误诊8例,妇科、肿瘤科误诊各2例。入我院后,结合腹部超声、CT检查表现,行超声引导下腹膜穿刺活检见黏液成分或黏液柱状上皮细胞,诊断为PMP。行手术治疗,术后病理诊断为PMP,7例术后辅以腹腔热灌注化疗。随访8~48个月,9例复发,其中4例未行腹腔热灌注化疗者8~16个月复发。结论 PMP临床少见,临床表现不典型,诊断困难;腹部超声、CT、腹腔穿刺活检联合检查有助于诊断;治疗以肿瘤细胞减灭术联合腹腔热灌注化疗为主,近期预后较好。Objective To investigate clinical characteristics and misdiagnosed causes of pseudomyxoma peritonei （PMP）. Methods Clinical data of 12 misdiagnosed patients with PMP admitted during March 2011 and March 2015 was ret- rospectively analyzed. Results The mainly clinical manifestations of 12 patients were progressive abdominal distention and seroperitoneum by abdominal CT and ultrasound examination, and tuberculosis antibody and tumor markers were positive in some patients. At primary diagnosis, 4 patients were misdiagnosed as having abdominal malignant tumor for further examination, 3 patients with cirrhosis seroperitoneum, 2 patients with ovarian neoplasms, 2 patients with tuberculous peritonitis and 1 patient with peritoneal metastatic tumor. Among them, 8 patients were misdiagnosed in gastroenterology department, 2 patients by gynaecology department and two patients by oncology department. After admitting in our hospital, PMP was confirmed by mucus tissues or columnar epithelium cells which were found by peritoneal biopsy under ultrasound and combination of results of abdominal ultrasound and CT examination. All patients underwent surgery, and PMP was confirmed by postoperative patho- logical results. Intraperitoneal hyperthermic perfusion chemotherapy was performed for 7 patients after operation. With 8-48 months of follow-up, 9 patients were found recurrence, among which 4 patients without intraperitoneal hyperthermic perfusion chemotherapy had a recurrence in postoperative 8-16 months. Conclusion PMP is rare, and its clinical manifestations are not typical, and therefore it is difficult to confirm diagnosis. Combined examination of abdominal ultrasound, CT and peritoneal biopsy is helpful for diagnosis. Cytoreduction combined with intraperitoneal hyperthermic perfusion chemotherapy is the main therapy for PMP patients with good short-term prognosis.

关 键 词：腹膜假黏液瘤 误诊 肝硬化 卵巢肿瘤 腹膜炎 结核性 化学疗法 肿瘤 局部灌注 

分 类 号：R735.5[医药卫生—肿瘤]