卵巢癌五例临床误诊分析
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摘要
目的分析卵巢癌误诊原因,以降低误诊率,提高诊治水平。方法回顾性分析我院2015年9月—2018年1月收治的误诊为其他疾病的卵巢癌5例的临床资料。结果本组因发热、下腹部疼痛、腹胀、低热、盗汗等原因入院,误诊为盆腔炎、黄体破裂各2例,结核性腹膜炎1例,误诊时间7～60 d,予相应处理病情均未见好转。为进一步诊治均行剖腹探查术,术中经组织病理学检查确诊为卵巢癌,其中4例行根治性手术,1例行姑息性手术,后病情稳定出院,嘱其出院后继续化疗。结论卵巢癌临床表现缺乏特异性,医生应加强对卵巢癌的认知、提高诊断思维能力、加强业务学习等多种能力的培养,或可减少或避免误诊的发生。
Objective To analyze the causes of misdiagnosis for ovarian cancer, in order to reduce misdiagnosis rate and improve the level of diagnosis and treatment. Methods The clinical data of 5 cases of ovarian cancer misdiagnosed as other diseases in our hospital from September 2015 to January 2018 were retrospectively analyzed. Results Patients were admitted to hospital due to fever, lower abdominal pain, abdominal distension, low fever, and night sweat.There were 2 cases misdiagnosed as pelvic inflammatory disease, 2 cases as rupture of corpus luteum, and 1 case as tuberculous peritonitis. The duration of misdiagnosis was 7 to 60 days, and the condition was not improved after corresponding treatment. All patients underwent exploratory laparotomy for further diagnosis and treatment. They were diagnosed with ovarian cancer by intraoperative histopathological examination. Four patients underwent radical surgery and one underwent palliative operation. They were discharged with stable disease, and recommended to continue to receive chemotherapy. Conclusion The clinical manifestations of ovarian cancer lack specificity. Doctors should strengthen their knowledge of ovarian cancer, improve their ability of thinking, and strengthen the cultivation of multiple abilities, which may help reduce or avoid misdiagnosis.
Objective To analyze the causes of misdiagnosis for ovarian cancer, in order to reduce misdiagnosis rate and improve the level of diagnosis and treatment. Methods The clinical data of 5 cases of ovarian cancer misdiagnosed as other diseases in our hospital from September 2015 to January 2018 were retrospectively analyzed. Results Patients were admitted to hospital due to fever, lower abdominal pain, abdominal distension, low fever, and night sweat.There were 2 cases misdiagnosed as pelvic inflammatory disease, 2 cases as rupture of corpus luteum, and 1 case as tuberculous peritonitis. The duration of misdiagnosis was 7 to 60 days, and the condition was not improved after corresponding treatment. All patients underwent exploratory laparotomy for further diagnosis and treatment. They were diagnosed with ovarian cancer by intraoperative histopathological examination. Four patients underwent radical surgery and one underwent palliative operation. They were discharged with stable disease, and recommended to continue to receive chemotherapy. Conclusion The clinical manifestations of ovarian cancer lack specificity. Doctors should strengthen their knowledge of ovarian cancer, improve their ability of thinking, and strengthen the cultivation of multiple abilities, which may help reduce or avoid misdiagnosis.
引文
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[13] 姚睿嫔,俞超芹,翟东霞,等.女性盆腔结核合并腹腔积液误诊为卵巢癌6例临床分析[J].现代肿瘤医学,2017,25(4):614-616.
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[16] 王亚萍,曹艳红,王玉凤,等.卵巢上皮性癌组织中P27kipl蛋白的表达及临床意义[J].武警医学院学报,2009,18(2):109-111.
[17] 叶金力,徐琳,邢天伶,等.中西医结合综合治疗盆腔炎的疗效分析[J].中华保健医学杂志,2018,20(2):147-148.
[18] 韩肖燕,金影,刘伟,等.阑尾周围脓肿误诊为妇科急腹症10例临床分析[J].中国计划生育和妇产科,2017,9(11):67-70.
[19] 王广洲,秦闫燕,卢洁,等.miR-1271对卵巢癌SKOV3/DDP细胞顺铂耐药的影响及其机制[J].江苏大学学报(医学版),2017,27(2):118-122.
[20] 邓锦芳,武艺,金力,等.直肠恶性间皮瘤误诊为卵巢癌一例并文献复习[J].临床误诊误治,2017,30(6):25-28.
[21] 杨华,陈建华.以胸腔积液为首发症状的卵巢癌多发转移一例[J].临床误诊误治,2017,30(10):31-33.
[22] 韩超,孔为民,刘婷婷.妊娠及围产期卵巢上皮性癌3例分析及文献回顾[J].癌症进展,2016,14(7):706-708.
[23] 邹媛媛,陶馨馨.卵巢子宫内膜异位症与卵巢癌的超声鉴别诊断[J].中国妇幼保健,2017,32(14):3362-3364.
[24] 张爽爽,夏庆民,郑荣寿,等.中国2010年卵巢癌发病与死亡分析[J].中国肿瘤,2016,25(3):169-173.
[25] 萨伊普加玛丽·米吉提,艾迪拜·木合买提,苏比努尔·买买提,等.HE4联合CA125及彩色多普勒超声在上皮性卵巢癌诊断中的价值[J].中国妇幼保健,2017,32(6):1324-1327.
[26] 高菲菲,郭垒,薛恺,等.卵巢淋巴瘤和以淋巴结转移为主的卵巢癌临床特征比较[J].中国癌症杂志,2017,27(4):281-286.
[2] 王强,张宇涛,孙静,等.紫杉醇联合顺铂治疗进展期卵巢癌临床疗效观察[J].中国药物与临床,2017,17(9):1334-1335.
[3] 于慧杰,宋秀军,张曼泽,等.叶酸受体α在卵巢癌靶向诊断和治疗中的应用[J].医学分子生物学杂志,2017,14(1):35-39.
[4] 金云峰,奚庆华,黄梦卉,等.钙结合蛋白S1OOA1在正常卵巢与卵巢癌组织中的表达研究[J].中国医药,2016,11(12):1836-1839.
[5] 谭歆.尿路上皮癌胚抗原1在卵巢癌组织中的表达及临床意义[J].江苏大学学报(医学版),2018,28(1):61-64.
[6] 彭晓澜,陈婷婷,尚祥,等.3.0T MRI对附件囊实性病变的诊断价值及误诊原因分析[J].磁共振成像,2016,7(7):512-518.
[7] 张洪连.多发性子宫肌瘤并发卵巢癌漏诊1例[J].中国煤炭工业医学杂志,2012,15(8):1257-1258.
[8] 叶馨,李毅.胃肠道转移性卵巢癌误诊分析及预后探讨[J].华西医学,2016,31(8):1394-1397.
[9] 廖东辉,岳青芬,黄好亮,等.卵巢癌诱发继发性纤溶亢进一例[J].中国综合临床,2016,32(12):1124-1125.
[10] 杨潇,王艳清,鲜舒,等.转录因子YY1在妇科肿瘤和妊娠疾病中的作用[J].医学分子生物学杂志,2017,14(4):239-245.
[11] Chen H,Zhou S Y,Sun Z Q.Prevalence of the three common gynecologic malignancies and their disease burden[J].China Journal of Modern Medicine,2015,25(6)108-112.
[12] 陈慧,周思园,孙振球.常见妇科三大恶性肿瘤的流行及疾病负担研究现状[J].中国现代医学杂志,2015,25(6):108-112.
[13] 姚睿嫔,俞超芹,翟东霞,等.女性盆腔结核合并腹腔积液误诊为卵巢癌6例临床分析[J].现代肿瘤医学,2017,25(4):614-616.
[14] 丁慧芳,薛萍,张宁.腹盆腔放线菌病误诊为卵巢癌[J].临床误诊误治,2017,30(4):14-15.
[15] 杨开兰,金龙,苏天昊.原发性卵巢癌误诊卵巢转移瘤1例[J].中国医学影像技术,2018,34(1):156.
[16] 王亚萍,曹艳红,王玉凤,等.卵巢上皮性癌组织中P27kipl蛋白的表达及临床意义[J].武警医学院学报,2009,18(2):109-111.
[17] 叶金力,徐琳,邢天伶,等.中西医结合综合治疗盆腔炎的疗效分析[J].中华保健医学杂志,2018,20(2):147-148.
[18] 韩肖燕,金影,刘伟,等.阑尾周围脓肿误诊为妇科急腹症10例临床分析[J].中国计划生育和妇产科,2017,9(11):67-70.
[19] 王广洲,秦闫燕,卢洁,等.miR-1271对卵巢癌SKOV3/DDP细胞顺铂耐药的影响及其机制[J].江苏大学学报(医学版),2017,27(2):118-122.
[20] 邓锦芳,武艺,金力,等.直肠恶性间皮瘤误诊为卵巢癌一例并文献复习[J].临床误诊误治,2017,30(6):25-28.
[21] 杨华,陈建华.以胸腔积液为首发症状的卵巢癌多发转移一例[J].临床误诊误治,2017,30(10):31-33.
[22] 韩超,孔为民,刘婷婷.妊娠及围产期卵巢上皮性癌3例分析及文献回顾[J].癌症进展,2016,14(7):706-708.
[23] 邹媛媛,陶馨馨.卵巢子宫内膜异位症与卵巢癌的超声鉴别诊断[J].中国妇幼保健,2017,32(14):3362-3364.
[24] 张爽爽,夏庆民,郑荣寿,等.中国2010年卵巢癌发病与死亡分析[J].中国肿瘤,2016,25(3):169-173.
[25] 萨伊普加玛丽·米吉提,艾迪拜·木合买提,苏比努尔·买买提,等.HE4联合CA125及彩色多普勒超声在上皮性卵巢癌诊断中的价值[J].中国妇幼保健,2017,32(6):1324-1327.
[26] 高菲菲,郭垒,薛恺,等.卵巢淋巴瘤和以淋巴结转移为主的卵巢癌临床特征比较[J].中国癌症杂志,2017,27(4):281-286.