心力衰竭合并多囊性腹膜间皮瘤所致难治性腹腔积液1例

摘要/Abstract

摘要： 目的探讨多囊性腹膜间皮瘤所致难治性腹腔积液的临床特点。方法对1例心功能Ⅳ级的多囊性腹膜间皮瘤病例资料进行回顾性分析。结果该例患者5年前冠状动脉支架术后出现阵发性喘憋,加重伴腹胀3月就诊,入院时双侧胸腔积液伴大量腹腔积液,超声心动提示“EF值23%”,其他检查暂未提示其他器质性及腹腔感染性疾病,考虑心源性腹腔积液。予以抗心力衰竭治疗后,症状缓解不明显,再次完善相关检查,发现腹膜多囊实性病变,确诊为“多囊性腹膜间皮瘤”。因患者全身耐受性极差,未予相关治疗,入院2个月后因循环衰竭死亡。结论腹膜间皮瘤发病罕见,缺乏特异性症状及检查,当心力衰竭反复出现难治性腹腔积液,并且用原发疾病心力衰竭无法进行合理解释时,应警惕腹膜间皮瘤的可能性,以免误诊误治。

关键词: 多囊性腹膜间皮瘤, 误诊, 心力衰竭, 腹腔积液

Abstract: Objective To investigate the clinical characteristics and causes of misdiagnosis of refractory ascites caused by benign multicystic peritoneal mesothelioma. Methods A case of benign multicystic peritoneal mesothelioma with grade Ⅳ cardiac function was misdiagnosed retrospectively. Results This patient had paroxysmal dyspnea after coronary stenting 5 years ago, aggravated with abdominal distension, and went to the hospital for 3 months. At admission, bilateral pleural effusion accompanied by a large amount of peritoneal effusion. Echocardiography showed "EF value 23%". Other examinations did not indicate other organic and abdominal infectious diseases, and cardiac peritoneal effusion was considered. After receiving anti heart failure treatment, the symptoms did not improve significantly. Further examination revealed polycystic solid lesions in the peritoneum, which was diagnosed as "polycystic mesothelioma of the peritoneum". Due to poor systemic tolerance, the patient did not receive any relevant treatment and died of circulatory failure 2 months after admission. Conclusion The incidence of peritoneal mesothelioma is extremely low, lack of specific symptoms and examination. If refractory ascites can not be explained by the primary disease, the possibility of peritoneal mesothelioma should be alert, so as to avoid misdiagnosis.

Key words: multicystic peritoneal mesothelioma, misdiagnosis, heart failure, ascites

中图分类号:

R735.5

李东东, 刘宝清, 仇欢. 心力衰竭合并多囊性腹膜间皮瘤所致难治性腹腔积液1例[J]. 中华养生保健, 2024, 42(23): 172-176.

LI Dong-dong, LIU Bao-qing, QIU Huan. Misdiagnosis and Misdiagnosis of Ascites Caused by Heart Failure with Polycystic Peritoneal Mesothelioma: A Case Report[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(23): 172-176.

参考文献

[1] CHA K S, CHOI Y H, LEE Y S, et al.Benign multicystic peritoneal mesothelioma treated with laparoendoscopic single site surgery: A case report and review of the literature[J]. Obstetrics & gynecology science,2018,61(1):170-174.
[2] 方宇婷, 杨文蔚, 牛雅茹, 等.恶性腹膜间皮瘤内科治疗的研究进展[J].中国肿瘤临床与康复,2023,30(5):300-305.
[3] KESHAVA H B, TANG A, SIDDIQUI H U, et al.Largely Unchanged Annual Incidence and Overall Survival of Pleural Mesothelioma in the USA[J]. World journal of surgery,2019,43(12):3239-3247.
[4] MOMENI M, PEREIRA E, GRIGORYAN G, et al.Multicystic benign cystic mesothelioma presenting as a pelvic mass[J]. Case reports in obstetrics and gynecology, 2014,2014: :852583.
[5] SHIN H D, KIM S B.Benign Cystic Mesothelioma Misdiagnosed as Peritoneal Carcinomatosis[J]. Case reports in gastroenterology,2016,10(1):115-120.
[6] FRONTARIO S C, LOVEITT A, GOLDENBERG-SANDAU A, et al.Primary Peritoneal Mesothelioma Resulting in Small Bowel Obstruction: A Case Report and Review of Literature[J]. The American journal of case reports,2015,16:496-500.
[7] 陈小兵, 苗成利, 罗成华. 恶性腹膜间皮瘤治疗及预后研究进展[J]. 中国微创外科杂志,2019,19(7):630-633.
[8] REMON J, REGUART N, CORRAL J, et al.Malignant pleural mesothelioma: new hope in the horizon with novel therapeutic strategies[J]. Cancer treatment reviews,2015,41(1):27-34.
[9] SHIH C A, HO S P, TSAY F W, et al.Diffuse malignant peritoneal mesothelioma[J]. The Kaohsiung journal of medical sciences,2013,29(11):642-645.
[10] 刘树洋, 刘彤, 李亮亮, 等. 恶性腹膜间皮瘤治疗方案研究进展[J]. 中华实验外科杂志,2024,1:173-176.
[11] MOHRI D, NAKAI Y, ISAYAMA H, et al.Malignant peritoneal mesothelioma diagnosed by EUS-guided tissue acquisition[J]. Endoscopic Ultrasound,2015,4(4):353-354.
[12] ZHA B S, FLANAGAN M, COULSON C, et al.Difficult to Identify: Malignant Primary Peritoneal Mesothelioma[J]. The American journal of medicine,2015,128(11):1191-1194.
[13] MANZINI V P, RECCHIA L, CAFFERATA M, et al.Malignant peritoneal mesothelioma: A multicenter study on 81 cases[J]. Annals of oncology : Official journal of the European Society for Medical Oncology,2010,21(2):348-353.
[14] ZHAO R, LU J, SHI Y, et al.Current management of refractory ascites in patients with cirrhosis[J]. The Journal of international medical research,2018,46(3):1138-1145.
[15] 郭旭,吴浩.肝静脉阻塞型布加综合征的研究进展[J].临床肝胆病杂志,2024,40(1):13-18.
[16] BAYRAKTAR U D, SEREN S, BAYRAKTAR Y.Hepatic venous outflow obstruction:Three similar syndromes[J]. World Journal of Gastroenterology,2007,(13):1912-1927.
[17] 苏加林, 丁文惠. 心源性腹水的诊断和治疗[J]. 中国医刊,2006,(8):17-20.
[18] SEVINC A, SARI R, FADILLIOGLU E.The utility of lactate dehydrogenase isoenzyme pattern in the diagnostic evaluation of malignant and nonmalignant ascites[J]. Journal of the National Medical Association,2005,97(1):79-84.
[19] 郑伦和, 段秋林, 郑剑波. 多指标联合检测在胸腹水鉴别诊断中临床价值研究[J]. 临床血液学杂志(输血与检验),2018,31(5):777-781.
[20] 邓懋清, 曹春芳, 黄浩南, 等. 胸腹水标中的病原菌分布及耐药性分析[J]. 实验与检验医学,2016,34(6):774-776.
[21] 吴水河,赵劲风,张文玲,等. 显色培养基检测504例真菌性胸腹水结果的分析[J]. 中国现代医学杂志,2003,(13):111-112.
[22] FAGOTTI A, PETRILLO M, COSTANTINI B, et al.Minimally invasive secondary cytoreduction plus HIPEC for recurrent ovarian cancer: a case series[J]. Gynecologic oncology,2014,132(2):303-306.
[23] EISENHAUER E L, SONODA Y, LEVINE D A.et al. Platinum resistance and impaired survival in patients with advanced primary peritoneal carcinoma: Matched-case comparison with patients with epithelial ovarian carcinoma[J]. American journal of obstetrics and gynecology,2008,198(2):213.e1-213.e7.
[24] EVANGELOPOULOU E A, ZACHARIS K, SKOUFI G, et al.Benign multicystic peritoneal mesothelioma in a postmenopausal woman complicated with an ovarian cyst:A case report[J].Pan Afr Med J,2021,40:171.
[25] 李鎛江, 曾家顺, 李龙. 系统性红斑狼疮罕见并发症乳糜腹水并脾梗死1例[J]. 中国实用内科杂志,2017,37(7):671-672.
[26] VOGELZANG N J, RUSTHOVEN J J, SYMANOWSKI J, et al.PhaseⅢstudy of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma[J]. J Clin Oncol,2003,21(14):2636-2644.
[27] ZALCMAN G, MAZIERES J, MARGERY J, et al.Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study(MAPS):A randomised, controlled, open-label, phase 3 trial[J].Lancet,2016,387(10026):1405-1414.