双侧卵巢巨大子宫内膜异位囊肿误诊及文献复习

目的分析1例双侧卵巢子宫内膜异位囊肿术前误诊的相关因素,HE4检测对上皮性卵巢恶性肿瘤诊断的价值,提高该病的术前诊断准确率,为制定手术计划、判断预后提供依据。方法回顾性分析本院2019年8月收治的1例巨大双侧子宫内膜异位囊肿患者的临床表现、CT等影像学检查、肿瘤标志物检查、术前诊断、术中所见、术后病理等,探讨总结误诊的原因。结果术前腹部CT检查显示:腹腔、盆腔多发囊实混合性占位性病变,考虑恶性肿瘤性病变。术前两次CA125分别为:2128 U/mL、3637 U/mL,HE4分别为>1500 U/mL、316.4 U/mL,体检:腹膨隆,脐上4横指触及一巨大囊实性肿物。2019年8月15日在喉罩全麻下“经腹双侧附件切除+盆腔巨大肿物切除+全子宫切除+阴道顶悬吊术+大网膜切除+重度盆腔粘连松解术”。术后病理结果显示:子宫内膜样囊肿。结论生育龄妇女患者盆腹腔巨大囊实性肿物,术前两次CA125检查呈上升趋势,但HE4明显下降,提示HE4检测可用于卵巢良恶性肿瘤的鉴别诊断。

Misdiagnosis and literature review of giant endometriosis cyst of bilateral ovary

Objective To analyze the related factors of misdiagnosis of bilateral ovarian endometriosis cyst before operation.To analyze the value of HE4 detection in the diagnosis of epithelial ovarian cancer.Improve the accuracy of preoperative diagnosis of the disease.To provide basis for making operation plan and judging prognosis.Methods Retrospective analysis of a case of huge bilateral endometriosis cyst in August 2019 in our hospital,According to the clinical manifestations of patients,CT and other imaging examination,tumor marker examination,preoperative diagnosis,intraoperative findings,postoperative pathology,etc.Discuss and summarize the causes of misdiagnosis.Results Preoperative CT findings of abdomen in our hospital:Multiple space occupying lesions of abdominal cavity and pelvic cavity,which were considered malignant lesions.CA125 were 2128 U/mL,3637 U/mL,HE4 were>1500 U/mL,316.4 U/mL respectively before operation.Physical examination:abdominal bulge,a huge cystic solid mass was touched by the 4 transverse fingers on the umbilicus.On August 15,2019,under general anesthesia with a laryngeal mask,the patient underwent"Transabdominal excision of bilateral adnexa of uterus,excision of giant pelvic masses,total hysterectomy,vaginal ceiling suspension,omentectomy,and lysis of severe pelvic adhesion."Postoperative pathological results showed that endometrioid cyst.Conclusion Huge cystic solid mass in pelvic and abdominal cavity of women of childbearing age,CA125 examinations twice showed upward trend before operation,however,HE4 decreased significantly,to summarize,HE4 detection can be used in the differential diagnosis of ovarian benign and malignant tumors.