FHCS综合征误诊胆囊炎分析及文献复习

Analysis of Misdiagnosis of FHCS Syndrome as Cholecystitis and Literature Review

摘要: 目的：探讨Fitz-Hugh-Curtis综合征临床特点，为临床医师提供诊断和治疗参考，降低误诊率。方法：回顾分析2017年4月至2020年11月我院以“胆囊炎”诊断收入院的11例Fitz-Hugh-Curtis综合征患者的临床资料。结果：Fitz-Hugh-Curtis综合征患者均为育龄期女性，平均年龄(33.6 ± 8.1)岁，11例均有右腹部压痛，5例阴道分泌物增多，宫颈举痛明显。CT见：8例肝包膜呈现不同程度增厚、强化；7例伴盆腔内子宫周围低密度液体影。腹腔镜探查：11例肝包膜及腹膜充血水肿，肝表面、胆囊周围、盆底有不同程度的渗出；5例纤维性粘连；4例输卵管充血水肿炎性改变。腹腔液检测：2例沙眼衣原体。盆腔液检测：1例淋病奈瑟菌；5例沙眼衣原体。宫颈分泌物检测：1例淋病奈瑟菌；7例沙眼衣原体；1例淋病奈瑟菌及沙眼衣原体。11例均行腹腔镜探查，5例粘连明显者给予粘连松解术并行留置引流管冲洗，术后经过抗生素治疗后痊愈。结论：育龄期女性单纯右上腹痛或者同时右下腹痛，应该考虑鉴别Fitz-Hugh-Curtis综合征，以防误诊、漏诊。

Abstract: Objective: To explore the clinical characteristics of Fitz-Hugh-Curtis syndrome, provide clinicians with diagnosis and treatment reference, and reduce the misdiagnosis rate. Methods: The clinical data of 11 patients with Fitz-Hugh-Curtis syndrome diagnosed as “cholecystitis” in our hospital from April 2017 to November 2020 were retrospectively analyzed. Results: All patients with Fitz-Hugh-Curtis syndrome were women of childbearing age, with an average age of (33.6 ± 8.1) years. 11 cases had tenderness in the right abdomen, 5 cases had increased vaginal secretions and obvious cervical pain. CT findings: 8 cases of hepatic capsule showed thickening and enhancement in varying degrees; 7 cases were accompanied by low-density liquid shadow around the uterus in the pelvic cavity. Laparoscopic exploration: 11 cases of congestion and edema of liver capsule and peritoneum, with varying degrees of exudation on the surface of liver, around gallbladder and pel-vic floor; 5 cases of fibrous adhesion; There were 4 cases of tubal congestion, edema and inflamma-tory changes. Peritoneal fluid detection: 2 cases of Chlamydia trachomatis. Detection of pelvic fluid: 1 case of Neisseria gonorrhoeae; 5 cases of Chlamydia trachomatis. Detection of cervical secretion: 1 case of Neisseria gonorrhoeae; 7 cases of Chlamydia trachomatis; 1 case was Neisseria gonorrhoeae and Chlamydia trachomatis. All 11 cases underwent laparoscopic exploration. 5 cases with obvious adhesion were treated with adhesion lysis and indwelling drainage tube irrigation. They were cured after antibiotic treatment. Conclusion: For women of childbearing age with simple right upper ab-dominal pain or simultaneous right lower abdominal pain, it should be considered to distinguish Fitz-Hugh-Curtis syndrome in order to prevent misdiagnosis and missed diagnosis.