侵犯肾静脉的Castleman病误诊临床分析  

Clinical Analysis of Misdiagnosis of Castleman's Disease with Renal Vein Invasion

作　　者：王永顺 刘乃青 WANG Yongshun;LIU Naiqing(School of Clinical Medicine,Shandong Second Medical University,Weifang,Shandong 261053,China;Department of General Surgery,Linyi Central Hospital,Linyi,Shandong 276400,China)

机构地区：[1]山东第二医科大学临床医学院,山东潍坊261053 [2]临沂市中心医院普外科,山东临沂276400

出　　处：《临床误诊误治》2024年第13期15-18,共4页Clinical Misdiagnosis & Mistherapy

基　　金：山东第二医科大学附属医院科技发展重点项目资助(2023FYZ017)。

摘　　要：目的探讨Castleman病(CD)的临床特点及鉴别诊断要点,以减少误诊误治。方法回顾性分析2023年收治的1例CD的临床资料,并复习相关文献。结果1例女性因发现腹腔占位10余天入院。入院完善相关检查,肿瘤标志物等未见异常。全腹部强化CT检查考虑畸胎瘤可能性大,腹膜后多发增大淋巴结。经多学科专家会诊后,行腹膜后病灶切除术、部分肾静脉切除术、肾静脉-下腔静脉自体大隐静脉搭桥术治疗,术后病理示CD,治愈出院。结论部分CD患者无明显临床表现,易误诊。临床鉴别CD与其他腹腔肿瘤时,应行多学科会诊并重视病理及免疫组织化学结果,仔细询问病史及查体,认真鉴别诊断,以减少或避免误诊误治。Objective To explore the clinical features of Castleman's disease(CD)and the key points of differential diagnosis,in order to reduce the misdiagnosis and mistreatment.Methods The clinical data of 1 patient with CD treated in 2023 were retrospectively analyzed,and the relevant literature was reviewed.Results One female was admitted to hospital due to abdominal space occupying for more than 10 d.After admission,the relevant examinations were performed,and no abnormalities were found in tumor markers.Enhanced CT examination of the whole abdomen suggested the possibility of teratoma and multiple enlarged retroperitoneal lymph nodes.After multidisciplinary expert consultation,retroperitoneal foci resection,partial renal venectomy,renal vena-inferior vena cava autologous great saphenous vein bypass surgery were performed.The postoperative pathology showed CD,and the patient was cured and discharged.Conclusion Several patients with CD have no obvious clinical manifestations and are more likely to experience misdiagnosis.In clinical differentiation of CD and other abdominal tumors,multidisciplinary consultation should be carried out,attention should be paid to pathological and immunohistochemical results,and careful medical history and physical examination,and careful differential diagnosis are needed to reduce or avoid misdiagnosis and mistreatment.

关 键 词：CASTLEMAN病 误诊 畸胎瘤 多学科联合 部分肾静脉切除术 肾静脉-下腔静脉自体大隐静脉搭桥术 病理检查 诊断 鉴别 

分 类 号：R733.4[医药卫生—肿瘤]