卵巢外腹膜癌19例误诊原因分析

An analysis of misdiagnosis of extraovarian peritoneal carcinoma in 19 cases

目的探讨卵巢外腹膜癌患者的临床误诊原因。方法回顾性分析19例卵巢外腹膜癌的临床表现、血肿瘤标志物、影像学特征、手术探查、病理学检查结果、治疗和预后。结果卵巢外腹膜癌最常见的临床表现为腹胀、腹痛和腹围增大。19例患者中，测定血中糖类抗原125（CA-125）者17例，15例升高，其中4例腹水中测得CA-125明显升高（〉10^4KU／L），12例腹水中找到癌细胞。19例患者中，有3例误诊为子宫来源肿瘤，13例误诊为附件肿瘤，1例误诊为膀胱、肠道来源肿瘤，其中仅有2例术前即诊断为腹膜肿瘤，误诊率89．47％（17／19）。术后病理结果得以证实为腹膜恶性肿瘤，5年生存率仅20％。结论无明显诱因的腹胀腹痛是本病的主要临床表现，仔细的体格检查有时可以提供重要信息，异常增高的血CA-125水平及腹水穿刺结果有助于卵巢外腹膜癌的诊断和鉴别诊断，CT对腹膜原发灶具有诊断价值。

Objective To analyze the misdiagnosis in extraovarian peritoneal carcinoma（EOPC）. Methods The clinical manifestation, blood tumor marker, imaging examination, laparotomy, pathology, treatment and prognosis of 19 EOPC patients were retrospectively analyzed. Results The clinical symptoms were abdominal distention, abdominal pain and swelling. 17 cases were tested for blood CA-125 with 15 at abnormaly high level, and in 4 cases ascites was CA-125 positive （ 〉10^4 KU/L）. Tumor cells were detected in the ascites in 12 cases. Three cases were misdiagnosed as of uterine origin, 13 cases misdiagnosed as adnexal tumor, 1 case was misdiagnosed as bladder and intestinal tumor. Only 2 cases were correctly diagnosed before the operation. All of the cases were pathologically proved as peritoneal carcinoma. The five-year survival rate was only 20 percent. Conclusions Abdominal distention and pain with unknown causes were the primary manifestations of EOPC, elaborate physical examination sometimes may provide with important information. The significant elevation of serum CA-125 and the ascites cytology may be helpul for the differential diagnosis of PPC. CT scan is valuable for the diagnosis of EOPC.