本文關(guān)鍵詞： 腹膜后腫瘤 婦科腫瘤 誤診　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析總結(jié)25例婦科探查手術(shù)中發(fā)現(xiàn)為腹膜后腫瘤患者的病例特點(diǎn),提高對腹膜后腫瘤的認(rèn)識,避免誤診為婦科腫瘤。材料與方法:收集2009年1月至2016年12月吉林大學(xué)第二醫(yī)院初診為婦科腫瘤并由婦科醫(yī)師手術(shù),術(shù)中發(fā)現(xiàn)為腹膜后腫物并經(jīng)病理證實為腹膜后腫瘤的患者25例,對其病史資料、輔助檢查、病理診斷等進(jìn)行回顧性總結(jié)分析。結(jié)果:1.本組患者共25例,年齡19-69歲,平均年齡45.4+13.32歲,其中40-60歲患者最多,占60%。2.本組患者共25例,其中15例為體檢時行婦科彩超發(fā)現(xiàn)的附件區(qū)或盆腔包塊;4例為自捫及下腹部包塊;4例表現(xiàn)為下腹痛;3例癥狀為腹脹;2例表現(xiàn)為腰痛;尿頻尿急、左下肢疼痛、痛經(jīng)、陰道出血各1例。3.本組患者共25例,均行婦科彩超檢查,其中3例行CT檢查,1例行MRI檢查。除了2例患者術(shù)前考慮子宮肌瘤未行腫瘤標(biāo)志物檢查,其余23例患者行婦科腫瘤標(biāo)志物檢查,檢查結(jié)果均在正常值范圍。4.本組患者25例,其中18例腫瘤鄰近膀胱、子宮、直腸,5例位于髂血管區(qū),2例位于腹主動脈旁;腫瘤最大體積為18cm*14cm*10cm,最小體積為4cm*4cm*3cm,4例惡性腫瘤直徑均超過10cm;23例腫瘤為單發(fā),2例為多發(fā)。5.本組患者25例,均行手術(shù)治療,其中完整切除19例,19例患者腫瘤包膜均完整,均無侵犯周圍臟器及血管,術(shù)后病理回報良性17例,惡性2例;部分切除5例,術(shù)后病理回報良性3例,惡性2例;其中1例因腫瘤與腹主動脈關(guān)系密切手術(shù)風(fēng)險大只行盆腔腫物活檢術(shù),術(shù)后病理回報為良性。6.本組患者25例,其中良性腫瘤21例,平滑肌瘤7例,神經(jīng)鞘瘤3例,castleman病2例,子宮內(nèi)膜異位2例,炎性腫物、淋巴管肌瘤、支氣管炎性囊腫、神經(jīng)纖維瘤、成熟性畸胎瘤、脂肪瘤、副神經(jīng)節(jié)瘤各1例;惡性腫瘤4例,其中脂肪肉瘤2例,炎性肌纖維母細(xì)胞瘤1例,未分化肉瘤1例。結(jié)論:1.腹膜后腫瘤較少發(fā)生,而臨床癥狀和婦科疾病相似,有時鑒別診斷困難,易被誤診為婦科腫瘤。2.詳細(xì)詢問患者病史、仔細(xì)查體及必要的輔助檢查有利于鑒別診斷。3.影像學(xué)檢查,尤其是婦科超聲是主要的輔助診斷方法,如果彩超提示雙測卵巢大小正常的附件區(qū)包塊,應(yīng)考慮腫物來源于腹膜后的可能,這說明超聲應(yīng)盡量顯示雙測卵巢,有助于對腫瘤來源進(jìn)行判斷。4.如果超聲提示腫塊過大,應(yīng)進(jìn)一步行CT、MRI檢查明確腫瘤部位和性質(zhì),當(dāng)腫物較大時CT、MRI對腹膜后腫物具有較高的診斷價值。5.婦科腫瘤標(biāo)志物可作為參考的指標(biāo),當(dāng)附件區(qū)或盆腔腫物較大考慮為惡性腫瘤時,如果患者無腹水、腫瘤標(biāo)志物不高時,應(yīng)考慮腹膜后腫物的可能性。6.尿路造影和與無痛胃鏡對排除疾病有一定價值。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.4

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