努克管囊肿：一个非常罕见的诊断的解剖学、诊断和治疗——一个成年女性的病例报告...

努克管囊肿：一个非常罕见的诊断的解剖学、诊断和治疗——一个成年女性的病例报告和文献回顾

Nuck 管囊肿是一种极为罕见的女性鞘膜积液，通常发生于儿童，但也可发生于成年女性。 它是由 Nuck 管病变引起的，Nuck 管在女性中相当于男性的鞘突。 由于其罕见性和医生缺乏认识，Nuck 管囊肿在临床实践中是一种很少遇到的实体，并且经常被误诊。 报告了一名 42 岁女性的 Nuck 管囊肿病例，她的右侧腹股沟出现疼痛性肿胀。 此外，对当前可用的文献进行了审查。 本综述概述了努克管囊肿的解剖学、病理学、诊断学和治疗。 本次综述的目的不仅是为了做一个调查，更是为了提高人们对Nuck管囊肿的认识，为医学专业人士提供参考。

女性鞘膜积液，即努克管囊肿，是一种极为罕见的实体，不常见，尤其是在成人中。 这种疾病的起源是胚胎发生过程中的病理。 临床上，女性鞘膜积液通常表现为腹股沟或生殖器区域肿胀，这可以进行多种鉴别诊断。 由于它的罕见性，大多数卫生专业人员都不知道它的存在，努克管囊肿经常被误诊。 需要精确诊断，包括彻底的临床检查和充分的放射学成像，以准确确定其存在。 报告了一名 42 岁女性的病例，她患有努克管囊肿到科室就诊。 该病例提供了对所使用的各种诊断程序的深入了解，描述了手术方法，并提供了有关组织学的信息。 此外，对现有文献进行了回顾，以总结世界各地不同医生的经验。 本综述提供了有关解剖学和发病机制的基本知识。 其次，概述了努克管囊肿的患病率。 提出了常用的分类并描述了诊断的症状和关键方面，从而能够区分女性腹股沟或生殖器肿胀的可能鉴别诊断。 此外，检查了治疗并讨论了不同的手术方法。 本综述应作为简编，以促进女性鞘膜积液的识别及其治疗。

一名 42 岁的女性患者因右侧腹股沟处有小肿胀，疑似腹股沟疝，被全科医生转诊至外科门诊。 患者在两个月前观察到这种肿胀，并在患处出现拖痛。 除两年前因子宫多发性肌瘤行子宫切除术和双侧输卵管切除术外，无腹部或盆腔手术史，无外伤史，其他健康状况良好，无恶心、呕吐表现。 体格检查发现右侧腹股沟区有一不可缩小的深部圆形肿瘤，大小约15×10 mm，无压痛。 余腹查体不明显，腹壁质软，有规律的蠕动音。 没有下肢无力的主诉。

超声检查可见右侧腹股沟区子宫圆韧带低回声囊性形成，无血管流动或蠕动。 无法确定由于 Valsalva 动作导致的大小或形状的变化。 获得磁共振成像 (MRI) 以进一步确定囊肿的范围和性质。 MRI 显示 15 × 9 × 16 mm（横向 × 矢状 × 头尾）边界清楚的囊性结构，在她的右腹股沟韧带的内侧边界内有周边对比增强，与腹膜腔没有可见的联系，符合 Nuck 管的鞘膜积液。 该鞘膜积液的轴向 T2 加权 MRI 图像显示在图 1 中。

努克管囊肿：一个非常罕见的诊断的解剖学、诊断和治疗——一个成年女性的病例报告...

图 1
轴位 T2 加权 MRI：位于右侧腹股沟管内的囊性结构，与腹膜腔没有联系。

努克管囊肿：一个非常罕见的诊断的解剖学、诊断和治疗——一个成年女性的病例报告...

图 2
从圆韧带剥离后 Nuck 管囊肿的术中图片。

努克管囊肿：一个非常罕见的诊断的解剖学、诊断和治疗——一个成年女性的病例报告...

图 3
组织学苏木精和伊红染色：位于纤维肌肉和脂肪组织内的囊性结构显示出扁平至立方体的间皮内层（左角），与 Nuck 管的鞘膜积液一致。

努克管囊肿：一个非常罕见的诊断的解剖学、诊断和治疗——一个成年女性的病例报告...

图 4
Nuck 的女性解剖结构和专利管示意图。

努克管囊肿：一个非常罕见的诊断的解剖学、诊断和治疗——一个成年女性的病例报告...

图 5
由 Counseller 和 Black 分类的 Nuck 管不同类型囊肿的示意图。

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