临床误诊误治

目的 探讨骶前囊肿误诊原因及防范误诊的措施。方法 分析2024年1月收治的1例误诊为子宫内膜异位症的骶前囊肿患者的诊疗经过，结合相关文献分析其误诊原因。结果 本例45岁女性，主要症状为月经紊乱伴左下腹隐痛，疼痛与月经周期无明显关系，平素大便次数多，盆腔CT检查提示双侧附件区多发囊性灶、直肠周围间隙积液积血，各实验室检查指标无特殊。误诊为子宫内膜异位症，行腹腔镜下盆腔病损切除、腹膜后肿块穿刺抽液术，并予醋酸亮丙瑞林缓释微球皮下注射治疗无效。2个月后因胆囊结石伴胆囊炎发作就诊，行磁共振检查考虑骶前囊肿，经手术病理检查明确诊断为尾肠囊肿，误诊时间4个月。经手术彻底切除囊肿，术后予常规抗感染、止痛等治疗，术后随访半年无复发。结论 骶前囊肿临床少见，症状缺乏特异性，早期诊断困难，易与其他疾病混淆；临床医师应当加强对本病的认识，详细询问患者病史、全面查体及多学科会诊，并且及早完善磁共振等影像学检查，充分评估病情，可有效避免漏误诊的发生。

Objective To explore the causes of misdiagnosis of anterior sacral cyst and the preventive measures. Methods The diagnosis and treatment of a case of anterior sacral cyst misdiagnosed as endometriosis admitted to hospital in January 2024 were analyzed, and the causes of misdiagnosis were analyzed according to relevant literature. Results The main symptoms of this 45-year-old female patient were menstrual disorder with dull pain in the left lower abdomen, which had no obvious relationship with menstrual cycle, frequent regular bowel movements, pelvic CT examination indicating multiple cystic lesions in bilateral accessory areas and fluid and blood accumulation in perirectal space, and no special laboratory examination indicators. Misdiagnosed as endometriosis, laparoscopic resection of pelvic lesion, retroperitoneal mass aspiration and subcutaneous injection of leuprelin acetate sustained release microspheres were not effective. Two months later, she was treated for cholecystolithiasis with cholecystitis. The MRI examination was completed and the anterior sacral cyst was considered. After surgical pathological examination, the diagnosis was confirmed as caudal intestinal cyst, and the misdiagnosis time was 2 months. There was no recurrence after half a year follow-up. Conclusion Presacral cyst is rare in clinic, the symptoms lack specificity, early diagnosis is difficult, and easy to be confused with other diseases. Clinicians should strengthen their understanding of the disease, inquire about the patient's history in detail, conduct a thorough physical examination and multidisciplinary consultation, and improve MRI and other imaging examinations as soon as possible to fully evaluate the condition, which can effectively avoid the occurrence of misdiagnosis.