摘要
目的探讨盆腹腔放线菌病的临床诊治要点和误诊原因,以减少误诊。方法回顾分析1例广泛盆腹腔放线菌病误诊病例资料,并复习相关文献。结果患者为57岁女性,因腹胀、腹痛、体重减轻、黑便、间断低热1月余入院。入院后多种影像学检查发现盆腔巨大占位性病变,侵犯多个腹腔脏器,子宫内膜增厚,查肿瘤标志物轻度升高。诊断为卵巢肿瘤、子宫腺肌症。行肿瘤细胞减灭术,术中见右盆腔一15 cm×18 cm×20 cm囊实性包块,侵及子宫、双附件、回盲部、乙状结肠及直肠上段、膀胱顶。术后病理检查示:大片化脓性病灶,其间可见成团的放射状菌丝,伴大量泡沫细胞反应的肉芽肿性炎。确诊为盆腹腔放线菌病。术后予大剂量足疗程青霉素治疗,随访1年无复发。结论盆腹腔放线菌病常形成包块侵及盆腹腔周围组织结构,易误诊为卵巢恶性肿瘤,组织病理学检查是确诊放线菌病的金标准。
Objective Aim To investigate clinical characteristics and misdiagnosed causes of abdominopelvic actinomycosis in order to avoid misdiagnosis.Methods Clinical data of 1 patient with widely abdominopelvic actinomycosis was retrospectively analyzed, and related literature review was also reviewed.Results A 57-years-old female was admitted for abdominal distension, abdominal pain, weight loss, dark stools and intermittent fever for more than 1 month.A huge pelvic occupying lesion, invading multiple organs, thickening endometrium and slightly increased levels of tumor markers were found by many kinds of iconography examinations.Ovarian neoplasm and adenomyosis were diagnosed.A 15 cm＆#215;18 cm＆#215;20 cm size of cystic-solid mass in right pelvic cavity was found during operation research, which had invaded uterus, annex, ileocecal junction, sigmoid colon, upper rectum and apex vesicae, and cytoreductive surgery was performed.Pathological analysis after the operation showed large-area purulent lesion and conglobate actinomycosis among it with lots of foam cells reacting granulomatous inflammation, and abdominopelvic actinomycosis was confirmed.Large dose enough-time Benzylpenicillin therapy was given after the operation, and no recurrence was found during 1-year follow-up.Conclusion Abdominopelvic actinomycosis usually forms mass and invading pelvic and surrounding tissues, and it is easily misdiagnosed of ovarial cancer.Histopathologic examination is the gold standard for confirmation of actinomycosis.
出处
《临床误诊误治》
2017年第4期10-13,共4页
Clinical Misdiagnosis & Mistherapy
关键词
放线菌病
盆腔
腹腔
误诊
卵巢肿瘤
Actinomycosis
Pelvic
Abdominal
Misdiagnosis
Ovarian neoplasms
