盆腔结核60例误诊原因分析

Misdiagnosis Analysis of Female Pelvic Tuberculosis(A Report of 60 Cases)

目的探讨盆腔结核的诊治要点及误诊原因。方法对我院收治并误诊的60例盆腔结核的临床资料进行回顾性分析。结果本组临床表现均不典型,查血常规示重度贫血10例,白蛋白下降24例;60例均行肿瘤标志物检测,血清癌抗原125(CA125)均升高,CA19-9升高11例,甲胎蛋白(AFP)正常。人绒毛膜促性腺激素(β-HCG)检查均正常。均行胸部X线检查,提示陈旧性结核病灶2例。B超检查示附件区或盆、腹腔囊实性、实性或囊性肿块56例,余考虑为附件区或盆腔占位性病变。57例行腹部CT检查示:中至大量腹腔积液24例,附件区或盆腔不规则实性或囊实性占位性病变56例,大网膜、腹膜或肠系膜呈结节状不规则增厚14例,腹膜后淋巴结增大8例,22例疑诊为附件恶性肿瘤伴盆腹腔内广泛转移。术后病理检查明确诊断为盆腔结核。结论盆腔结核多病程缓慢,缺乏典型临床症状。借助B超引导下穿刺、腹腔镜检查可减少盆腔结核的误诊误治。

Objective To analyze the diagnosis,treatment,and misdiagnosis causes of female pelvic tuberculosis.Methods The clinical data of 60 pelvic tuberculosis patients misdiagnosed in our hospital was retrospectively analyzed.Results The clinical manifestation in all the patients was atypical.Blood routine examination showed severe anemia in 10 patients and decreased leucocyte in 24 patients.60 patients underwent tumor marker detection,which showed increased CA 125 and normal levels of AFP and β-HCG in all the patients,and increased CA199 in 11 patients.X-ray examination on the chest showed obsolete tuberculose focus in 2 patients.Type-B ultrasonography confirmed that 56 patient were spina bifida cystica and solid lump,and solid or spina bifida cystica lump in adnexa region or abdominopelvic cavity,other patients were confirmed as occupying lesion in adnexa region or cavitas pelvis.57 patients underwent abdominal CT examination,which showed medium to mass seroperitoneum in 24 patients,abnormal solid or spina bifida cystica in adnexa region or cavitas pelvis in 56 patients,nodose abnormal thickening in greater omentum,peritoneum,and mesentery in 14 patients,and lymphadenovarix behind peritoneum in 8 patients.22 cases were misdiagnosed as malignancy with extensive intrapelvic metastasis.All the patients were diagnosed as pelvic tuberculosis by pathology after surgery.Conclusion Pelvic tuberculosis has slow pathogenesis and atypical clinical manifestations.Paracentesis under type-B ultrasonic and laparoscopy can avoid misdiagnosis of tuberculosis.