腹膜后肿物误诊为妇科肿瘤的原因分析

发布时间：2018-02-28 12:43

本文关键词： 腹膜后肿瘤妇科肿瘤误诊　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析总结25例妇科探查手术中发现为腹膜后肿瘤患者的病例特点,提高对腹膜后肿瘤的认识,避免误诊为妇科肿瘤。材料与方法:收集2009年1月至2016年12月吉林大学第二医院初诊为妇科肿瘤并由妇科医师手术,术中发现为腹膜后肿物并经病理证实为腹膜后肿瘤的患者25例,对其病史资料、辅助检查、病理诊断等进行回顾性总结分析。结果:1.本组患者共25例,年龄19-69岁,平均年龄45.4+13.32岁,其中40-60岁患者最多,占60%。2.本组患者共25例,其中15例为体检时行妇科彩超发现的附件区或盆腔包块;4例为自扪及下腹部包块;4例表现为下腹痛;3例症状为腹胀;2例表现为腰痛;尿频尿急、左下肢疼痛、痛经、阴道出血各1例。3.本组患者共25例,均行妇科彩超检查,其中3例行CT检查,1例行MRI检查。除了2例患者术前考虑子宫肌瘤未行肿瘤标志物检查,其余23例患者行妇科肿瘤标志物检查,检查结果均在正常值范围。4.本组患者25例,其中18例肿瘤邻近膀胱、子宫、直肠,5例位于髂血管区,2例位于腹主动脉旁;肿瘤最大体积为18cm*14cm*10cm,最小体积为4cm*4cm*3cm,4例恶性肿瘤直径均超过10cm;23例肿瘤为单发,2例为多发。5.本组患者25例,均行手术治疗,其中完整切除19例,19例患者肿瘤包膜均完整,均无侵犯周围脏器及血管,术后病理回报良性17例,恶性2例;部分切除5例,术后病理回报良性3例,恶性2例;其中1例因肿瘤与腹主动脉关系密切手术风险大只行盆腔肿物活检术,术后病理回报为良性。6.本组患者25例,其中良性肿瘤21例,平滑肌瘤7例,神经鞘瘤3例,castleman病2例,子宫内膜异位2例,炎性肿物、淋巴管肌瘤、支气管炎性囊肿、神经纤维瘤、成熟性畸胎瘤、脂肪瘤、副神经节瘤各1例;恶性肿瘤4例,其中脂肪肉瘤2例,炎性肌纤维母细胞瘤1例,未分化肉瘤1例。结论:1.腹膜后肿瘤较少发生,而临床症状和妇科疾病相似,有时鉴别诊断困难,易被误诊为妇科肿瘤。2.详细询问患者病史、仔细查体及必要的辅助检查有利于鉴别诊断。3.影像学检查,尤其是妇科超声是主要的辅助诊断方法,如果彩超提示双测卵巢大小正常的附件区包块,应考虑肿物来源于腹膜后的可能,这说明超声应尽量显示双测卵巢,有助于对肿瘤来源进行判断。4.如果超声提示肿块过大,应进一步行CT、MRI检查明确肿瘤部位和性质,当肿物较大时CT、MRI对腹膜后肿物具有较高的诊断价值。5.妇科肿瘤标志物可作为参考的指标,当附件区或盆腔肿物较大考虑为恶性肿瘤时,如果患者无腹水、肿瘤标志物不高时,应考虑腹膜后肿物的可能性。6.尿路造影和与无痛胃镜对排除疾病有一定价值。
[Abstract]:Objective: to analyze and summarize the characteristics of 25 cases of retroperitoneal tumor found in gynecological exploration operation, and to improve the understanding of retroperitoneal tumor. Materials and methods: from January 2009 to December 2016, the first diagnosis of gynecological tumors in the second Hospital of Jilin University was performed by gynecologists. Twenty five patients with retroperitoneal tumor confirmed by pathology during operation were retrospectively analyzed for their history, auxiliary examination, pathological diagnosis and so on. Results: 1. There were 25 cases in this group, aged 19 to 69 years old, in this group, 25 cases were diagnosed as retroperitoneal tumor, and 25 cases were diagnosed as retroperitoneal neoplasms, and 25 cases were diagnosed as retroperitoneal neoplasms by pathology. The average age was 45.4 13.32 years old, of which 40-60 years old patients were the most, accounting for 60.2. there were 25 patients in this group. Of them, 15 cases were diagnosed by gynecological ultrasound, 4 cases were diagnosed as the adnexal area or pelvic mass, 4 cases were self-palpable lower abdominal mass, 4 cases were lower abdominal pain, 3 cases were abdominal distention, 2 cases were low back pain, 2 cases were dysuria, left lower extremity pain, dysmenorrhea, dysphagia, dysmenorrhea, dysuria, dysphagia, dysmenorrhea, There were 25 cases of vaginal hemorrhage in this group, all of them underwent gynecological color Doppler examination, 3 cases of them were examined by CT and 1 case by MRI. Except for 2 cases of uterine myoma, the tumor markers were not examined before operation. The other 23 patients were examined with gynecological tumor markers, and the results were all within the normal value range. 25 cases were in this group. Among them, 18 cases were adjacent to the bladder, 5 cases were located in the iliac vascular area, 2 cases were located near the abdominal aorta, 18 cases were adjacent to the bladder, 5 cases were located in the iliac vascular area. The maximum volume of tumor was 18 cm ~ (14) cm ~ (-1) 10 cm, the minimum volume was 4 cm ~ 4 cm ~ (-1) 3 cm ~ (-1), the diameter of 4 malignant tumors were all over 10 cm ~ (-1), 23 cases were single tumor and 2 cases were multiple. All the 25 cases were treated by operation, 19 cases of which were completely resected and 19 cases of tumor capsule were all intact. 17 cases were benign and 2 cases malignant, 5 cases were partial resection, 3 cases were benign and 2 cases malignant. One patient underwent pelvic mass biopsy only because of the close relationship between tumor and abdominal aorta, and the pathological results were benign. There were 25 cases of benign tumor, 7 cases of leiomyoma, 3 cases of neurilemmoma, 2 cases of schwannoma, 2 cases of benign tumor, 7 cases of leiomyoma and 2 cases of schwannoma. Endometriosis 2 cases, inflammatory tumor, lymphangiomyoma, bronchitis cyst, neurofibroma, mature teratoma, lipoma, paraganglioma 1 case, malignant tumor 4 cases, liposarcoma 2 cases. There were 1 case of inflammatory myofibroblastoma and 1 case of undifferentiated sarcomas. Conclusion 1. Retroperitoneal tumors occur less frequently, but clinical symptoms are similar to gynecologic diseases, sometimes differential diagnosis is difficult, and easily misdiagnosed as gynecologic tumors. Careful examination of body and necessary auxiliary examination are helpful for differential diagnosis. 3. Imaging examination, especially gynecological ultrasound, is the main auxiliary diagnostic method. If the color ultrasound indicates that the adnexal block of normal ovarian size is double measured, Consideration should be given to the possibility that the tumor originates from the retroperitoneum, which suggests that ultrasound should show as much as possible the double ovary, which is helpful for judging the origin of the tumor .4.If the ultrasound indicates that the tumor is too large, the location and nature of the tumor should be further determined by CT MRI. 5. Gynecological tumor markers can be used as a reference index. When the adnexal area or pelvic tumor is considered as malignant tumor, if the patient has no ascites, the tumor marker is not high. The possibility of retroperitoneal mass should be considered. 6. Urography and painless gastroscopy are valuable in eliminating diseases.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.4

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