CA125升高的盆腔结核误诊为卵巢癌12例报告

Misdiagnosis of pelvic tuberculosis as ovarian cancer: Clinical analysis in 12 cases characterized by elevated CA125

目的：探讨CA125升高的女性盆腔结核误诊为卵巢癌的原因，分析其与卵巢癌的鉴别要点及预防误诊措施。方法：回顾分析2003年5月～2013年12月我院12例盆腔结核患者误诊为卵巢癌的临床资料。结果：平均年龄（39．5±6．5）岁（15～69岁），血清CA125均升高，平均值（264．5±8．4）U/ml（48．7～616．9 U/ml），所有患者均主要表现为腹胀，5例明显消瘦，6例合并腹痛，2例合并月经改变，2例合并发热；B超检查提示10例盆腔可探及包块，8例盆腔探及少到大量积液，3例伴胸腔积液，胸腹水查抗酸杆菌均阴性；初步诊断考虑卵巢癌可能性大，经腹腔镜或开腹探查病理证实为盆腔结核。所有患者术后均接受抗结核治疗，10例治愈，1例术后16个月死于肠穿孔，1例失访。结论：卵巢癌与盆腔结核在发病年龄、临床症状、实验室及影像学检查等方面有多个相似之处，容易混淆，但仔细分析，能降低误诊率，从而减少不必要的过度治疗，改善预后。

Objective：To conduct the root cause analysis for misdiagnosis of pelvic tuberculosis as ovarian cancer on elevated CA 125 basis for approaches to differential diagnosis.Methods：The clinical data were retrospectively analyzed in 12 patients with pelvic tuberculosis misdiagnosed as ovarian cancer in Yijishan Hospital between May 2003 and December 2013.Results：The patients aged from 15 to 69 years old with a mean age of 36.2 ＆#177;11.5 years,and elevated serum CA125 by from 48.7 to 616.9U/ml[mean （264.5 ＆#177;8.4） U /ml],and were characterized by complaint of abdominal distension,signifi-cant weight loss （5 cases）,abdominal pain（6 cases）,menstrual change（2 cases）,or fever（2 cases）.Ultrasound examination revealed pelvic mass in 9 cases and pelvic effusion to a certain degree in 8.Pleural effusion occurred in 3 cases,yet confirmed negative for acid-fast bacilli by laboratory work.The total patients were initially suspected as diagnosed as ovarian cancer and underwent either laparoscopy or laparotomy ,yet confirmed as pelvic tuberculosis on biopsy basis and received anti-TB therapy.Ten patients were cured,one died 16 months after the surgery due to intestinal perforation,and another one failed to be followed.Conclusion：Ovarian cancer resembles somewhat pelvic tuberculosis by the patient′s age,clinical symptoms,laboratory and imaging findings,which tends to lead to misdiagnosis.Nevertheless,careful analysis of the clinical data may prevent error diagnosis and over-treatment,but improve the prognosis.