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腰椎管肿瘤临床误诊探析

Analysis of Clinical Misdiagnosis of Lumbar Spinal Canal Tumors

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目的 分析腰椎管肿瘤临床误诊原因.方法 回顾性分析2022 年2 月至2023 年2 月初诊为腰椎间盘突出症的腰椎管肿瘤患者2 例的临床资料.结果 1 例下肢疼痛、麻木伴腰部疼痛 6 个月,根据临床症状、体征及腰椎CT检查考虑为腰椎间盘突出症,经综合保守治疗后无效,后经腰椎磁共振成像及手术病理检查确诊为腰椎管内血管淋巴管瘤.误诊时间91 d.术后随访1 年未见复发.1 例反复腰痛伴下肢乏力1 月余,根据临床症状、体征及腰椎X线检查,初诊为腰椎间盘突出症,保守治疗后症状呈进行性加重.考虑到患者长期吸烟史,行腰椎磁共振成像、全身PET-CT、经支气管镜取材活检及手术病理检查证实为肺癌腰椎管内转移瘤.误诊时间 35 d.术后辅助放化疗,随访1 年肺部原发灶继续缩小,未见新的转移灶,患者生活质量良好.结论 临床发现腰腿痛、下肢麻木等患者按腰椎间盘突出症对症治疗后效果不佳时,应提高警惕性,注意与腰椎管肿瘤鉴别,及早行磁共振成像检查,可降低误诊率.
Objective To analyze the causes of clinical misdiagnosis of lumbar spinal canal tumors.Methods From February 2022 to February 2023,the clinical data of 2 patients with lumbar spinal canal tumor who were initially diagnosed with lumbar disc herniation were retrospectively analyzed.Results A case of lower limb pain and numbness with lumbar pain for 6 months was considered to have lumbar disc herniation according to clinical symptoms,signs and CT examination of lum-bar spine.Comprehensive conservative treatment was ineffective.After lumbar magnetic resonance imaging(MRI)and surgi-cal pathological examination,it was confirmed to be lumbar intraspinal hemangilymphangioma.The misdiagnosis lasted 91 d.No recurrence was observed at 1-year follow-up.A case presented with recurrent low back pain accompanied by weakness of lower limbs for more than 1 month.Based on clinical symptoms,signs and lumbar X-ray examination,the initial diagnosis was lumbar disc herniation,and the symptoms showed progressive aggravation after conservative treatment.Considering the patient's long history of smoking,lumbar MRI,whole-body PET-CT examination,bronchoscopic biopsy,and surgical patholo-gy confirmed that the patient had metastasis of lung cancer to lumbar spinal canal.The misdiagnosis lasted 35 d.After postop-erative adjuvant chemoradiotherapy,during the follow-up period of 1 year,the primary lung lesions continued to shrink,no new metastases were found,and the patient had good quality of life.Conclusion In clinical practice,for patients with lower back pain,leg pain and lower limb numbness who had poor results after symptomatic treatment for lumbar disc herniation,vig-ilance should be increased,attention should be paid to differentiation from lumbar canal tumors,and MRI should be performed as soon as possible,thereby reducing the misdiagnosis rate.

NeoplasmsSpinal canalMisdiagnosisIntervertebral disc displacementMagnetic resonance imagingPathologyDiagnosis

姚光伟、何昌隆、张韬、薛朝亚

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066000 河北 秦皇岛,北京大学第三医院秦皇岛医院运动医学科

肿瘤 椎管 误诊 椎间盘移位 磁共振成像 病理 诊断

2025

临床误诊误治
解放军白求恩国际和平医院

临床误诊误治

影响因子:0.914
ISSN:1002-3429
年,卷(期):2025.38(1)