临床误诊误治

目的 总结肠道子宫内膜异位症(BE)的临床特点，探讨有效提高此类疾病诊断准确率的方法，避免误诊的发生。方法 回顾分析2020年至2024年因消化道症状就诊并初诊为消化道恶性肿瘤的30例BE患者临床资料。结果 30例患者年龄28～77岁，26例有生育史,7例已绝经，4例有明确痛经史。病变部位：直肠24例，乙状结肠5例，回肠末端1例。反复腹痛者14例，便血者12例，大便习惯改变者10例，腹胀者6例，肛门坠胀感、排便困难或里急后重者3例；癌抗原125升高10例，癌抗原19-9升高4例。30例行腹部CT检查均显示肠壁不规则增厚，提示消化道肿瘤可能。30例后经结肠镜活检和手术病理免疫组织化学染色确诊为BE。误诊时间4～11 d。确诊后30例均行手术治疗，且4例联合药物治疗，术后随访1年，患者情况良好，未见复发。结论 仅根据患者临床症状、影像学表现、结肠镜检查结果，临床医生初诊时很难将BE与消化道恶性肿瘤区分开来，内镜活检也存在误诊可能，故需要通过深挖活检或超声内镜引导下细针穿刺及手术病理免疫组织化学染色，才可明确诊断，降低误诊率。

Objective To summarize the clinical characteristics of bowel endometriosis(BE), and to explore the methods to effectively improve the diagnostic accuracy of this disease, so as to avoid misdiagnosis. Methods Clinical data of 30 BE patients with gastrointestinal symptoms and newly diagnosed gastrointestinal malignant tumors from 2020 to 2024 were retrospectively analyzed. Results The age of the 30 patients ranged from 28 to 77 years, 26 patients had a history of childbearing,7 patients were postmenopausal, and 4 patients had a history of dysmenorrhea. The lesions located in rectum(24 cases), sigmoid colon(5 cases)and terminal ileum(1 case). There was recurrent abdominal pain(n=14), hematochezia(n=12), change of bowel habits(n=10),abdominal distension(n=6), and anal heaviness, difficult defecation or tenesmus(n=3). Cancer antigen 125 increased in 10 patients and cancer antigen 199 increased in 4 patients. Abdominal CT examination showed irregular thickening of the intestinal wall in 30patients, suggesting the possibility of gastrointestinal tumors. Thirty patients were diagnosed with BE by colonoscopic biopsy, surgical pathology and immunohistochemical staining. The misdiagnosis time ranged from 4 to 11 days. After diagnosis, all patients underwent surgical treatment, and 4 patients were treated with drugs. The patients were followed up for 1 year, and the patients were in good condition without recurrence. Conclusion It is difficult to distinguish BE from gastrointestinal malignant tumors only based on the clinical symptoms, imaging findings and colonoscopy results. Endoscopic biopsy may also lead to misdiagnosis. Therefore, deep biopsy or endoscopic ultrasound-guided fine needle puncture and accurate surgical pathology and immunohistochemical staining are necessary to confirm the diagnosis and reduce the misdiagnosis rate.