女性盆腔结核误诊原因分析  

Analysis of Misdiagnosed Causes of Patients with Female Pelvic Tuberculosis

作　　者：罗玉玲 王江珊 李超男 LUO Yu-ling;WANG Jiang-shan;LI Chao-nan(Department of Gynaecology and Obstetrics,the Sixth Medical Center of PLA General Hospital,Beijing 100010,China)

机构地区：[1]解放军总医院第六医学中心妇产科,北京100010

出　　处：《临床误诊误治》2022年第6期5-8,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨女性盆腔结核(FGT)的误诊原因及防范误诊措施,以提高临床诊断率。方法回顾性分析2019年2月—2021年5月收治的14例FGT误诊病例的临床资料。结果本组均为女性,年龄24~48岁,9例因发现盆腔实性或囊性包块、盆腔积液、腹胀腹痛、血清癌抗原125(CA125)升高误诊为卵巢癌;5例因低热、发现盆腔实性或囊性包块伴局部触痛、血常规异常、盆腔肿痛误诊为盆腔脓肿。本组初步诊断后均择期行剖腹探查术,经手术病理检查,并结合患者临床表现及相关医技检查结果确诊为FGT,误诊时间7 d~1个月。本组确诊后予标准、全程、联合抗结核治疗,并随访1年,2例失访,余未见复发。结论FGT临床表现不典型,患者常无结核感染或密切接触史,临床表现与卵巢癌、盆腔炎性肿物相似,尤其伴血清CA125升高者极易误诊。故临床医生应加强对FGT的认识,熟知其临床特征及医技检查特点,必要时可行腹腔镜检查以提高诊断率。Objective To explore misdiagnosed causes and preventive measures of patients with female pelvic tuberculosis(FGT)in order to improve the clinical diagnosis rate.Methods Clinical data of 14 misdiagnosed patients with FGT admitted between February 2019 and May 2021 was retrospectively analyzed.Results All the patients were females aged from 24 to 48 years old.Among the patients,9 patients were misdiagnosed as having ovarian cancer due to finding pelvic solid or cystic mass,pelvic hydrops,abdominal distension and abdominal pain,and elevated serum cancer antigen 125(CA125),and another 5 patients were misdiagnosed as having pelvic abscess due to low-grade fever,pelvic solid or cystic mass complicated by local tenderness,abnormal blood routine and pelvic swelling and pain.After the initial diagnosis,selective exploratory laparotomy was performed in this group,and the FGT was confirmed after surgical and pathological examinations,combined with clinical manifestations and related results of medical examinations.The misdiagnosed duration was 7 d to 1 month.All patients received standard,full course and combined anti-tuberculosis treatment after comfirmation,and were followed up for 1 year.Two patients were lost to follow-up,and no recurrence was found in the remaining patients.Conclusion Clinical manifestations of FGT are atypical,and patients generally have no history of tuberculosis infection or close contact.It is likely to be misdiagnosed because of similar clinical manifestations with ovarian cancer and pelvic abscess,especially elevated serum CA125.Therefore,clinicians should strengthen their understanding of FGT,be familiar with its clinical characteristics and characteristics of medical examinations,and perform laparoscopy when necessary to improve the diagnostic rate.

关 键 词：盆腔结核 女性 误诊 卵巢肿瘤 盆腔脓肿 诊断 鉴别 

分 类 号：R527.5[医药卫生—内科学]