前列腺结核与前列腺癌临床误诊分析  

Analysis of Clinical Misdiagnosis of Prostate Tuberculosis and Prostate Cancer

作　　者：卫宜锐 王浩 杨朴深 何威峰 谢大炜 王建文[1] WEI Yirui;WANG Hao;YANG Pushen;HE Weifeng;XIE Dawei;WANG Jianwen(Department of Urology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,北京100020

出　　处：《临床误诊误治》2024年第9期1-5,共5页Clinical Misdiagnosis & Mistherapy

基　　金：首都卫生发展科研专项项目(首发2020⁃2⁃2033)。

摘　　要：目的分析前列腺结核(PTB)及前列腺癌(PCa)的临床特点、诊断和鉴别诊断措施,以及误诊原因、防范措施。方法回顾性分析2019年1月—2024年1月收治的曾误诊的2例PTB及1例PCa的临床资料。结果3例均表现为排尿困难、排尿等待、尿流变细或分叉以及尿频和尿急等典型的下尿路症状。根据临床表现及相关医技检查,2例误诊为PCa,1例误诊为PTB。误诊为PCa的2例经直肠前列腺穿刺活检,最终确诊为PTB,1例于外院接受规律抗结核治疗,1例拒绝接受进一步治疗。误诊为PTB的1例经尿道前列腺电切术后病理检查确诊为PCa,术后随访显示无肿瘤生化复发迹象。结论PTB及PCa临床表现有相似性,可相互误诊。PTB在临床相对罕见,其临床表现无明显特异性,容易误诊,临床医生应警惕PTB,以免延误治疗。Objective To analyze clinical features,diagnosis and differential diagnosis,causes of misdiagnosis and preventive measures of prostate tuberculosis(PTB)and prostate cancer(PCa).Methods The clinical data of 2 patients with PTB and 1 patient with PCa diagnosed with misdiagnosis from January 2019 to January 2024 were retrospectively analyzed.Results All three patients presented with typical lower urinary tract symptoms,such as dysuria,urine waiting,fine or bifurcated urine flow,frequent and urgent urination.According to the clinical manifestations and relevant medical and technical examination,2 patients were misdiagnosed with PCa and 1 with PTB.In 2 patients misdiagnosed with PCa.the re-sults of transrectal prostate biopsy indicated that the final diagnosis was PTB,of whom 1 patient received regular anti-tubercu-losis therapy in another hospital,and 1 patient declined further treatment.One patient misdiagnosed as PTB was confirmed as having PCa by pathological examination after transurethral resection of the prostate,and no signs of tumor biochemical recur-rence were found after postoperative follow-up.Conclusion The clinical manifestations of PTB and PCa are similar and can be misdiagnosed.PTB is relatively rare in clinical practice,and its clinical manifestations have no obvious specificity,which,therefore,is more likely to be misdiagnosed.Clinicians should be vigilant of the presence of PTB to prevent delayed treatment.

关 键 词：前列腺结核 前列腺肿瘤 误诊 病理学 前列腺特异性抗原 结核分枝杆菌 磁共振成像 

分 类 号：R527.4[医药卫生—内科学]