子宫内膜癌临床误诊分析

Analysis of Clinical Misdiagnosis of Endometrial Carcinoma

目的探讨子宫内膜癌临床特点及误诊原因,并分析防范误诊措施。方法回顾性分析2018年2月—2019年4月收治初期曾误诊的15例子宫内膜癌的临床资料。结果本组阴道不规则出血12例,月经紊乱(周期缩短、经期延长)6例,痛经3例,性交出血1例,白带增多6例,白带异味2例,下腹胀痛2例,腰酸2例;均面色苍白,贫血貌。经妇科检查结合阴道超声表现,初步诊断为子宫肌瘤5例、子宫腺肌病6例、子宫内膜不典型增生4例,本组误诊时间1~3个月。拟行手术治疗,术中剖视子宫,见鱼肉样不规则内膜病变组织,经术中及术后病理检查提示子宫内膜癌,腺癌13例、腺角化癌2例。15例确诊后,给予经腹全子宫+附件切除7例和次广泛子宫及附件切除术8例,并术后辅以放疗。15例术后随访1年均存活且未复发。结论子宫内膜癌早期临床表现缺乏特异性,且发病有年轻化趋势,患者及接诊医师重视程度不足,未及时行组织病理学检查,是导致本病误诊及延误诊治的主要原因;加强对本病的认识,提高警惕性,对怀疑本病者及早行组织病理学检查,是避免早期误诊的有效方法。

Objective To explore the clinical characteristics and causes of misdiagnosis of endometrial carcinoma,and to analyze the measures to prevent misdiagnosis.Methods Clinical data of 15 patients with endometrial carcinoma who were initially misdiagnosed in hospital from February 2018 to April 2019 were retrospectively analyzed.Results In this group,there were 12 cases of irregular vaginal bleeding,6 cases of menstrual disorder(shortened cycle and prolonged period),3 cases of dysmenorrhea,1 case of bleeding during sexual intercourse,6 cases of increased leucorrhea,2 cases of leucorrhea odor,2 cases of abdominal distension and pain,and 2 cases of soreness of waist.All patients were pale and anaemic.After gynecological examination combined with transvaginal ultrasonography,5 cases of uterine fibroids,6 cases of adenomyosis,and 4 cases of endometrial atypical hyperplasia were preliminarily diagnosed.The duration of misdiagnosis was 1-3 months.Surgical treatment was planned.During intraoperative dissection of the uterus,fish-like irregular endometrial lesions were found.Pathological examination during and after operation revealed endometrial carcinoma,including adenocarcinoma in 13 cases and adenokeratosis in 2 cases.After diagnosis,transabdominal total hysterectomy plus adnexectomy(7 cases)and subextensive hysterectomy and adnexectomy(8 cases)were performed,followed by radiotherapy.All 15 patients were followed up for 1 year after surgery and survived without recurrence.Conclusion The main causes of misdiagnosis and delayed diagnosis of endometrial cancer are the lack of specificity of early clinical manifestations,the tendency of younger-age onset,the insufficient attention of patients and attending physicians,and the lack of histopathological examination.It is an effective way to avoid early misdiagnosis to strengthen the understanding and vigilance of the disease and to conduct histopathological examination for suspected patients.