术前误诊为浆膜下子宫肌瘤的卵巢纤维瘤临床误诊分析

Clinical Misdiagnosis of Ovarian Fibroma Misdiagnosed as Subserous Myoma before Operation

目的探讨卵巢纤维瘤术前误诊为浆膜下子宫肌瘤的原因及防范措施。方法对2019年4月—2021年5月收治的术前一度误诊为浆膜下子宫肌瘤的卵巢纤维瘤10例的临床资料进行回顾性分析。结果本组均体检发现左侧单发盆腔肿物,5例出现下腹痛及坠胀感,3例出现腰痛,2例出现尿频、尿急,伴阴道不规则出血3例。超声检查皆于子宫左上方探及一均质团块状低回声。初步诊断为浆膜下子宫肌瘤,行手术治疗,经术后病理结合临床确诊为卵巢纤维瘤。误诊时间1~2 d。10例均行全子宫双附件切除,术后切口愈合后出院。结论临床上无腹腔积液且以盆腔肿物、下腹坠胀、阴道不规则出血、肿瘤压迫症状就诊,超声检查亦不能明确肿瘤来源的卵巢纤维瘤患者,术前极易误诊为子宫肌瘤。加强对该病认识,及早行阴道彩色多普勒超声检查,必要时行手术病理检查,可减少或避免该病误诊误治。

Objective To analyze the causes of misdiagnosis of ovarian fibroma as subserous myoma before operation.Methods The clinical data of 10 patients with ovarian fibroma who were admitted from April 2019 to May 2021 and misdiagnosed as subserous myoma before operation were retrospectively analyzed.Results The mass was detected in the upper left part of the uterus in all patients.There were 5 cases with lower abdominal pain and distension,3 cases with low back pain,2 cases with frequent and urgent urination,and 3 cases with irregular vaginal bleeding.Ultrasound examination showed a homogenous mass of low echo in the upper left part of the uterus in all patients.A preliminary diagnosis of subserous myoma was made and surgical treatment was proposed.Ovarian fibroma was confirmed by the postoperative pathological examination combined with clinical diagnosis.The duration of misdiagnosis was 1-2 d.All 10 cases underwent total hysterectomy of double adnexa and were discharged after incision healing.Conclusion In patients without ascites,with pelvic masses,lower abdominal distension,irregular vaginal bleeding,and tumor compression symptoms,and ultrasound examination can not identify the source of the tumor,it is more likely to be misdiagnosed as uterine fibroma before surgery.Strengthening the understanding of the disease,early vaginal color Doppler ultrasonography,and surgical pathological examination when necessary can effectively avoid or reduce misdiagnosis and mistreatment of ovarian fibroma.