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女性盆腔结核临床特点及误诊为卵巢癌原因分析 被引量:1

Clinical Characteristics and Causes of Misdiagnosis of Female Pelvic Tuberculosis as Ovarian Cancer
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摘要 目的探讨女性盆腔结核的临床特点及诊断、鉴别诊断要点,以减少误诊。方法回顾性分析2019年3月—2021年1月收治的女性盆腔结核被误诊为卵巢癌12例的临床资料。结果本组12例年龄22~58岁,均有下腹部包块,腹胀、下腹隐痛或坠痛9例,食欲缺乏、体质量下降6例,午后发热、盗汗2例,经量少且周期紊乱10例。妇科检查均触及盆腔囊实性单侧包块;腹部移动性浊音阳性5例。8例血癌抗原125(CA125)升高,5例行腹水检查均呈浅黄色或淡绿色,查找抗酸杆菌、癌细胞均阴性。12例行腹部B超示子宫旁囊实性肿块,形态不规则,界限不清。12例均初步诊断为卵巢癌。误诊时间为5~12 d。行剖腹探查术,术中见盆腔腹膜、大网膜、肠管、盆腔脏器表面布满粟粒状结节,子宫与附件、肠管形成大小不等不规则包块及包裹性积液,取盆腔粘连组织送病理检查,确诊为盆腔结核,予抗结核、抗感染及营养支持等对症治疗,2个月后症状明显好转出院,出院后继续予抗结核治疗,随访1年均无复发。结论女性盆腔结核易误诊为卵巢癌,尤其是合并腹水且血CA125升高时更难以诊断。提高对该病认识,及早行相关检查,仔细鉴别诊断,有助于该病尽早确诊并治疗。 Objective To explore the clinical characteristics,diagnosis and differential diagnosis of female pelvic tuberculosis in order to reduce the occurrence of clinical misdiagnosis.Methods The clinical data of 12 patients with female pelvic tuberculosis misdiagnosed as ovarian cancer treated in our hospital from March 2019 to January 2021 were retrospectively analyzed.Results In this group,all 12 patients aged 22-58 years had inferior abdominal mass,abdominal distension,abdominal dull pain or falling pain in 9 cases,lack of appetite and decreased body mass in 6 cases,afternoon fever and night sweats in 2 cases,and low menstrual volume and cycle disturbance in 10 cases.Gynecological examination all showed solid unilateral pelvic cystic mass.Five patients had positive flap of abdominal mobility.The blood cancer antigen 125(CA125)was elevated in 8 cases,and the ascites examination in 5 cases showed light yellow or light green,acid-fast bacilli and cancer cells were negative.Abdominal B-ultrasonography of 12 cases showed parastuterine cystic mass with irregular shape and unclear boundary.All 12 cases were preliminarily diagnosed as ovarian cancer.Misdiagnosis lasted from 5 to 12 d.During exploratory laparotomy,the surface of pelvic peritoneum,greater omentum,bowel and pelvic organs were covered with miliary nodules,and irregular masses of different sizes and encapsulated effusion were formed in the uterus,adnexa and bowel.The pelvic adhesive tissue was taken for pathological examination and diagnosed as pelvic tuberculosis.The patient was given symptomatic treatment including anti-tuberculosis,anti-infection and nutritional support,and the symptoms improved significantly after 2 months.Anti-tuberculosis therapy was continued after discharge,and there was no recurrence at 1-year follow-up.Conclusion Female pelvic tuberculosis is more likely to be misdiagnosed as ovarian cancer,especially when combined with ascites and elevated blood CA125.Improving the understanding of the disease,early examination and careful differential diagnosis are helpful for early diagnosis and treatment of the disease.
作者 刘澈 代晟 刘怡 姚升娇 LIU Che;DAI Sheng;LIU Yi;YAO Sheng-jiao(Department of Obstetrics and Gynecology,Beijing Sixth Hospital,Beijing 100054,China)
出处 《临床误诊误治》 CAS 2022年第12期8-11,共4页 Clinical Misdiagnosis & Mistherapy
关键词 盆腔结核 女性 误诊 卵巢肿瘤 腹水 癌抗原125 Pelvic tuberculosis Female sex Misdiagnosis Ovarian tumor Ascites Cancer antigen 125
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