成人腹膜后畸胎瘤误诊分析及诊治体会  

Misdiagnosis Analysis and Treatment of Retroperitoneal Teratoma in Adults

作　　者：龚梦[1] 申复进[1] 许学先[1] GONG Meng;SHEN Fu-jin;XU Xue-xian(The Third Department of Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, China)

机构地区：[1]武汉大学人民医院妇三科,武汉430060

出　　处：《临床误诊误治》2019年第5期12-17,共6页Clinical Misdiagnosis & Mistherapy

基　　金：国家自然科学基金青年项目(8100395)

摘　　要：目的探讨成人腹膜后畸胎瘤的诊治方法及误诊原因、防范措施。方法对曾误诊的3例成人腹膜后畸胎瘤的临床资料进行回顾性分析。结果 3例年龄52岁、39岁和47岁,分别因体格检查发现盆腔肿物1年,增大1周;体格检查发现附件肿物6年,增大1个月;右侧腰骶部疼痛1年,加重4个月入院。初期均误诊,2例误诊为附件肿物,1例误诊为子宫畸形。2例于术中病理检查确诊腹膜后畸胎瘤,1例腹腔镜探查术中未能找到盆腔肿物,后根据盆腔MRI检查结果经妇科检查及直肠指诊定位后经阴道手术后病理检查确诊腹膜后畸胎瘤;3例病理检查均证实为成熟畸胎瘤。3例术后均恢复良好,随访3个月～2年未发现异常。结论成人腹膜后畸胎瘤临床少见,且肿瘤位置隐蔽,易误诊。临床遇及类似本文患者时需同时进行妇科检查及直肠指诊,并完善盆腔CT或MRI检查明确肿瘤部位,以减少误诊误治。ObjectiveThe aim of our study was to explore the methods of diagnosis and treatment, causes of misdiagnosis and preventive measures of retroperitoneal teratoma in adults. MethodsThe clinical data of three patients with retroperitoneal teratoma who were initially misdiagnosed were retrospectively analyzed. ResultsThree (aged 55, 39, and 47 years respectively) patients presented to our hospital due to pelvic mass for 1 week, which was enlarged in the past one month, adnexal mass of six years revealed by physical examination, and pain in right lumbosacral region for 1 year, which was aggravated for 4 months, respectively. They were misdiagnosed as adnexal masses in two cases and uterine malformation in one case. Two cases were diagnosed with retroperitoneal teratoma by intraoperative pathological examination. Pelvic mass was not found in the other case after laparoscopic exploration, and retroperitoneal teratoma was diagnosed and confirmed pathologically after transvaginal surgery according to the results of pelvic MRI examination, gynecological examination and digital rectal examination. Pathology reports of the three patients confirmed mature cystic teratoma. All patients recovered well after operation, and no abnormalities were found during three months to two-year follow-up. ConclusionRetroperitoneal teratoma in adults is rare in clinical practice, and the location of the tumor is concealed and easily misdiagnosed. It is necessary to identify the tumor location by performing gynecological examination and rectal examination as well as the pelvic CT or MRI scan in order to reduce misdiagnosis of retroperitoneal teratoma or other similar tumors in clinical practice.

关 键 词：畸胎瘤 腹膜后肿瘤 成人 误诊 附件肿瘤 子宫畸形 

分 类 号：R730.269[医药卫生—肿瘤] R735.4[医药卫生—临床医学]