胸腹腔肿瘤误诊28例临床研究

Clinical research about 28 misdiagnosis cases of splanchnocoel turner

目的探讨胸腹腔肿瘤误诊的原因及预防策略。方法对28例因主要表现为肢体肿痛被确诊为深静脉血栓形成(DVT)的胸腹腔肿瘤患者的临床资料进行回顾分析。对该组抗凝、祛聚、溶栓治疗效果不佳或复发的DVT患者常规进行腹腔B超、胸部X线摄片,腹腔肿瘤标志物检测,并根据其检查结果选择性作胸腹部CT、结肠镜、胃镜以及手术活检或切除病检等方法进行诊断。结果同期深静脉血栓形成病例总数743例,患肿瘤的DVT病例数(含肿瘤手术)102例,占13.7%,误诊28例,误诊率达27.4%(28/102)。本组28例误诊患者被诊断为原发性肝癌4例,腹腔淋巴瘤7例,结肠癌4例,直肠上段腺癌2例,卵巢癌2例,胃癌2例,腹膜后神经纤维瘤1例,肺癌5例,纵隔淋巴瘤1例。结论肿瘤是DVT的重要危险因素。临床上对年龄大于或等于40岁、近期无重大外伤史、无手术史、妊娠分娩史、长期制动或主动运动障碍史的患者发生DVT,尤其是血栓治疗效果不佳或复发、多发者,应注意搜寻肿瘤因素。

Objective To study the reason and strategy of preservation. Methods The clinical data of 28 splanchnocoel turner cases were reviewed retrospectively,and they were all diagnosed deep venous thrombosis（DVT） because of their swell and pain of limbs. We took abdominal ultrasound,X-ray and detect tumor markers to the DVT cases which recurrenced or therapeutic efficacy were negative with anticoagulation and thrombolysis. And we diagnosed them by splanchnocoel CT, colonoscope, gastroscope and operation with the results of examination. Results In 743 DVT cases,there were 102 turner cases,which were 13.7% ; 28 misdiag- nosis cases, which were 27.4 %. In 28 misdiagnosis cases, there were 4 primary hepatic carcinoma cases, 7 abdominal leucoma cases, 2 intestinum rectum adenocareinoma cases, 2 ovarian cancer cases, 5 lung cancer cases, 1 postperitoneum fibroneuroma case and 1 mediastinal lymphoma case. Conclusion Turner is the most risk factor of DVT. In clinic,when we meet the patients who are over 40, having no injury history, no operation history, no pregnancy history and no longtime breakdown or dyskinesia history, especially recurrenced or therapeutic efficacy was negative,we should try to find the turner factor.