作　　者： (陈凤）; (胥进）;

机构地区： 凉山彝族自治州第二人民医院呼吸内科,四川凉山彝族自治州615000

出　　处： 《临床误诊误治》 2017年第8期1-4,共4页

摘　　要： 目的探讨支气管结核误诊为肺癌的原因及防范措施。方法对2013年3月—2015年12月凉山彝族自治州第二人民医院呼吸内科收治的25例支气管结核中曾误诊为支气管肺癌7例的临床资料进行回顾性分析。结果本组误诊率为28.00%。出现咳嗽6例,咳痰5例,痰中带血或少量咯血4例,持续发热时间>2周4例,胸闷3例,胸痛2例,乏力、盗汗3例,食欲不振、体重下降2例。就诊初期6例误诊为支气管肺癌,1例误诊为支气管肺癌合并肺结核。误诊时间为1~12个月。按误诊疾病予相应处理患者病情变化不明显,后经电子支气管镜检查及反复多次纤维支气管镜下支气管黏膜活组织病理检查、刷检涂片查找抗酸杆菌确诊为支气管结核。7例均予规范抗结核等治疗,其中行手术切除治疗1例,支架安置术1例。7例治疗1个月后症状均有所缓解,复查胸部X线或CT示病灶较前吸收;住院治疗1~5个月后出院,院外继续行抗结核治疗。结论支气管结核因临床表现不典型,胸部X线及CT征象类似于肺癌,易误诊为肺癌。临床接诊类似本文患者时应及时行电子支气管镜检查及反复多次行纤维支气管镜下支气管黏膜活组织病理检查、刷检涂片查找抗酸杆菌,以尽早确诊。 Objective To investigate causes and preventative measures of bronchial tuberculosis misdiagnosed as lung cancer.Methods Clinical data of 7 patients misdiagnosed as having bronchial lung cancer, among whom 25 patients had bronchial tuberculosis admitted during march 2013 and December 2015, was retrospectively analyzed.Results The misdiagnosis rate was 28.00%.There were 6 patients with cough, 5 with expectoration, 4 with blood in phlegm or a little of haemoptysis, 4 with sustained fever for longer than 2 weeks, 3 with dyspnea, 2 with chest pain, 3 with fatigue and night sweats and 2 patients with poor appetite and weight loss.In primary diagnosis, 6 patients were misdiagnosed as having bronchial lung cancer, and 1 was misdiagnosed as having bronchopneumonia combined with pulmonary tuberculosis.Misdiagnosed time was 1-12 months.Patients＇＇ conditions did not obviously improve after corresponding treatment for misdiagnosed diseases.Bronchial tuberculosis was confirmed after bronchovideoscopy, repeated bronchial mucosal histopathologic examination under fiberoptic bronchoscopy and brushing smear for finding acid fast bacilli.The 7 patients received treatments such as anti-tuberculosis routine therapy, which included 1 patient with surgical resection and 1 with stent placement.Symptoms of the 7 patients were relieved after treatment for 1 month, and rechecking chest X-ray or CT showed that lesions were absorbed compared with those before treatment.The patients were discharged after hospitalization for 1-5 months, and anti-tuberculosis therapy was continued after discharging.Conclusion Bronchial tuberculosis is easily misdiagnosed as lung cancer because of atypically clinical manifestations, and similar manifestations to lung cancer by X-ray and CT examinations.Patients with similar manifestations to the patients in this study should give bronchovideoscopy, repeated bronchial mucosal histopathologic examination under fiberoptic bronchoscopy and brushing smear for finding acid fast bacilli in time in order to confirm

关 键 词： 结核 支气管 误诊 肺肿瘤