输卵管–卵巢脓肿误诊为卵巢恶性肿瘤一例

A Case of Tubo-Ovarian Abscess Disguising as Ovarian Malignancy

摘要: 病史摘要：患者，女，48岁，因“下腹痛2周，扪及盆腔包块1周”就诊于我院。患者2周前经期出现下腹隐痛，伴腹泻，无发热，无腹胀，无异常阴道流液等不适。腹泻症状持续3天后自行好转。1周前患者扪及下腹部包块，质硬，平脐，伴肛门坠胀感。影像学检查提示：卵巢恶性肿瘤可能性大。排除手术禁忌后行手术治疗，术中诊断为：输卵管–卵巢脓肿。术后予以抗生素抗感染治疗。专科检查：阴道内见少许白色分泌物，无腥臭味；宫颈光滑，质韧，盆腔扪及实性包块，大小约20*20 cm，双侧达盆壁，上极平脐，下极达子宫直肠陷凹，活动性差，压痛明显，未扪及双侧附件区。直肠指诊：进指3 cm处可触及质硬包块，活动度差，界限不清，凸向直肠，退指指套无血染。诊断方法：妇科超声、盆腔核磁共振等影像学检查，肿瘤标志物，术中所见及术后病理。治疗方法：排除禁忌后行手术治疗，术后予以对症治疗。临床转归：患者术后恢复可，无发热，无阴道流血等不适。适合阅读人群：妇科，普外科，影像科。

Abstract: Summary of case history: A 48-year-old woman was admitted to our hospital due to “Lower ab-dominal pain for 2 weeks, palpable pelvic mass for 1 week”. 2 weeks ago, she presented with pro-gressively aggravated abdominal pain and diarrhea without fever during menstruation. Diarrhea Symptoms disappeared after 3 days. One week ago, the patient had palpable mass in the lower ab-domen, hard and flat umbilicus, accompanied by a sense of anal distension. The pelvic ultraso-nograms illustrated complex pelvic masses highly suspicious for neoplasm. Surgical exploration revealed tubo-ovarian abscess. Antibiotic anti-infection treatment was given after operation. Symptoms and signs: There was a little white secretion in vagina, no peculiar smell. The cervix was smooth and tough. Solid and hardly removable mass was palpable in the pelvic cavity with a size of about 20*20 cm, bilateral reaching pelvic walls, the upper flat to the umbilical cord, the lower reaching uterine rectum depression, while bilateral adnexal areas were untouched. Digital rectal examination: hard mass can be touched at 3 cm into the finger, immovable and unclear boundary, convex to the rectum. No blood stained on the back finger sleeve. Diagnostic methods: Based on auxiliary examination results such as gynecological ultrasound, pelvic magnetic resonance imaging and tumor markers, the diagnosis was confirmed by intraoperative findings and postoperative pa-thology. Therapeutic methods: After eliminating contraindications, surgical treatment was per-formed. And symptomatic treatment was given after surgery. Clinical outcomes: The patient has recovered after treatment without fever, vaginal bleeding and other discomfort. It’s suitable for reading: department of gynecology, general surgery and imaging.