妊娠期宫颈癌临床误诊分析  

Clinical Misdiagnosis of Cervical Cancer During Pregnancy

作　　者：张状[1] 姜晓丹 刘鑫 ZHANG Zhuang;JIANG Xiaodan;LIU Xin(Department of Medical Imaging,the Second Hospital of Qinhuangdao City,Qinhuangdao,Hebei 066600,China;Department of Gynecology,the Second Hospital of Qinhuangdao City,Qinhuangdao,Hebei 066600,China;Department of Oncology,the Second Hospital of Qinhuangdao City,Qinhuangdao,Hebei 066600,China)

机构地区：[1]秦皇岛市第二医院医学影像科,河北秦皇岛066600 [2]秦皇岛市第二医院妇科,河北秦皇岛066600 [3]秦皇岛市第二医院肿瘤科,河北秦皇岛066600

出　　处：《临床误诊误治》2024年第1期1-4,共4页Clinical Misdiagnosis & Mistherapy

基　　金：秦皇岛市科学技术研究与发展计划项目(202004A078)。

摘　　要：目的探讨妊娠期宫颈癌临床误诊的原因及防范措施。方法回顾性分析2020年1月—2021年12月收治的曾有误诊经过的妊娠期宫颈癌3例临床资料。结果3例均因妊娠期阴道出血、腹痛或阴道分泌物异常就诊。1例考虑为先兆早产,剖宫产术后行MRI检查发现宫颈明显不规则增厚伴异常信号,经增厚组织病理检查确诊为宫颈低分化鳞状细胞癌(鳞癌);1例考虑为先兆流产,妇科检查发现宫颈有一赘生物,经宫颈活检确诊为宫颈中分化鳞癌;1例考虑为前置胎盘,剖宫产术后宫颈内口触及胎盘样组织,腹部超声示宫颈与宫体结合部占位性病变,病理活检示宫颈鳞癌。误诊时间2 d~4个月。3例确诊后予宫颈癌根治术联合术后放疗,随访半年情况良好。结论妊娠期宫颈癌临床少见,临床对以妊娠期出现不规则阴道出血、腹痛及分泌物异常增多就诊者提高警惕,以减少误诊。Objective To explore the causes of misdiagnosis and preventive measures of cervical cancer during pregnancy in clinical practice.Methods The clinical data of 3 patients with misdiagnosed cervical cancer during pregnancy admitted to our hospital from January 2020 to December 2021 were retrospectively analyzed.Results All the three cases presented with vaginal bleeding,abdominal pain or abnormal vaginal discharge during pregnancy.Threatened premature birth was considered in one patient.MRI examination after cesarean section revealed obvious irregular thickening of the cervix with abnormal signals,and the thickening histopathological examination confirmed poorly differentiated squamous cell carcinoma of the cervix(squamous cell carcinoma).Threatened abortion was considered in one patient,gynecological examination revealed a neoplasm in the cervix,and cervical biopsy confirmed it as cervical medium-differentiated squamous carcinoma.Placenta previa was considered in one patient.After cesarean section,placentlike tissue was palpated in the inner cervical opening.Abdominal ultrasound showed space-occupying lesions at the junction of the cervix and uterus,and pathological biopsy showed cervical squamous cell carcinoma.Misdiagnosis lasted from 2 days to 4 months.After diagnosis,3 patients received radical resection of cervical cancer combined with postoperative radiotherapy,and were in good condition at 6-month follow-up.Conclusion Cervical cancer during pregnancy is rare in clinical practice.For patients with irregular vaginal bleeding,abdominal pain and abnormal increase of secretions during pregnancy,clinicians should be vigilant to reduce misdiagnosis.

关 键 词：宫颈肿瘤 妊娠并发症 误诊 先兆早产 先兆流产 前置胎盘 阴道检查 宫颈活检 

分 类 号：R737.33[医药卫生—肿瘤]