误诊为妇科肿瘤的58例临床病例分析  

Analysis of 58 Clinical Cases Misdiagnosed as Gynecological Tumors

作　　者：许阡 成九梅[1] XU Qian;CHENG Jiu-mei(Gynecology Minimally Invasive Center,Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院妇科微创中心,100006

出　　处：《国际妇产科学杂志》2023年第3期297-301,共5页Journal of International Obstetrics and Gynecology

摘　　要：目的:探讨误诊为妇科肿瘤的临床病例特点,提高妇科医生对盆腔非生殖系统肿瘤的认知及诊断能力。方法:回顾性分析2009年8月—2022年3月首都医科大学附属北京妇产医院收治的58例误诊为妇科肿瘤收治入院患者的病例资料,经术中探查及病理学诊断证实腹膜后肿瘤24例,阑尾肿瘤15例,肠或肠系膜肿瘤19例,分别分析其临床特点、影像学表现、手术方式及术后病理诊断。结果:24例腹膜后肿瘤患者术前误诊为附件肿物18例(75.0%),误诊为子宫肌瘤或阔韧带肌瘤5例(20.8%),误诊为盆腔炎性包块1例(4.2%)。临床表现为腹痛或下腹部坠胀6例(25.0%),尿频2例(8.3%),大便不畅伴骶尾部不适1例(4.2%),无明显症状15例(62.5%)。超声或盆腔磁共振成像(magnetic resonance imaging,MRI)检查均未提示腹膜后肿物可能,仅1例患者盆腹腔增强CT提示不除外腹膜后肿物可能。15例阑尾肿瘤患者术前均误诊为附件肿物;临床表现为腹痛或下腹部坠胀6例(40.0%),无明显症状9例(60.0%);超声均未提示阑尾肿物来源可能,3例盆腹腔CT或盆腔增强MRI提示不除外阑尾来源肿瘤可能。19例肠或肠系膜肿瘤患者术前误诊为附件肿物18例(94.7%),1例(5.3%)误诊为浆膜下肌瘤;临床表现为腹痛或下腹部坠胀8例(42.1%),无明显症状11例(57.9%);超声提示不除外肠系膜囊肿1例,CT及MRI均未提示肠或肠系膜肿物可能。结论:腹膜后肿瘤、阑尾肿瘤、肠或肠系膜肿瘤的术前影像学多提示为盆腔肿物,多无特异性临床症状,难以与妇科肿瘤鉴别,且无特异性肿瘤标志物及影像学鉴别依据,术前常误诊为妇科肿瘤,妇科医生应对上述肿瘤引起重视,对提示附件肿物的患者仔细辨别,避免误诊。Objective:To explore the characteristics of clinical cases misdiagnosed as gynecological tumors and to improve the knowledge and diagnostic ability of pelvic non-genital system tumors.Methods:A retrospective analysis of the case data of 58 patients admitted between August 2009 and March 2022 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University who were misdiagnosed as gynecological tumors,all of which were confirmed to be non-genital tumors by intraoperative exploration and pathology,including 24 cases of retroperitoneal tumors,15 cases of appendiceal tumors and 19 cases of intestinal or mesenteric tumors.The clinical features,imaging manifestations,surgical methods and pathological diagnosis were analyzed.Results:Twenty-four patients with retroperitoneal tumors were preoperatively misdiagnosed as adnexal masses in 18 cases(75.0%),as uterine fibroids or broad ligament fibroids in 5 cases(20.8%),and as inflammatory pelvic masses in 1 case(4.2%).The clinical manifestations were abdominal pain or lower abdominal cramping in 6 cases(25.0%),frequent urination in 2 cases(8.3%),dyspareunia with sacrococcygeal discomfort in 1 case(4.2%),and no obvious symptoms in 15 cases(62.5%).Ultrasound or pelvic magnetic resonance imaging(MRI)did not suggest the possibility of retroperitoneal masses,and only one patient had pelvic and abdominal CT enhancement that did not exclude the possibility of retroperitoneal masses.In 15 patients with appendiceal tumors,all patients were misdiagnosed as adnexal tumors before surgery.The clinical manifestations were abdominal pain or lower abdominal distension in 6 cases(40.0%),and no obvious symptoms in 9 cases(60.0%).None of the patients had ultrasound suggesting a possible source of the appendiceal mass,and 3 patients had CT or MRI suggesting possible tumors of appendicular origin.19 patients with intestinal or mesenteric tumors were misdiagnosed as having an adnexal mass in 18 cases(94.7%),a case(5.3%)was misdiagnosed as subserous myoma.The clinical manifestations

关 键 词：误诊 盆腔肿瘤 腹膜后肿瘤 阑尾肿瘤 肠肿瘤 肠系膜肿瘤 

分 类 号：R737.3[医药卫生—肿瘤]