肺结核诊断为肺癌误治分析  

A case analysis of misdiagnosis of pulmonary tuberculosis as lung cancer

作　　者：温东东[1] 邓伟雄[1] 张年伟[1] 罗建威[1] 

机构地区：[1]广东广州市第一人民医院胸外科,510180

出　　处：《中国基层医药》2004年第5期555-556,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的　提高肺结核与肺癌的鉴别诊断水平 ,减少误诊 ,避免误治。方法　分析本科 4年来术前诊断为肺癌、术后病理报告为肺结核的原因 ,提出鉴别要点。结果　本组误诊率 4 5 2 3% (19/ 2 2 ) ,占同期诊断为肺癌手术治疗的 8 19% (19/ 2 32 )。其中影像学判断错误 14例 ,纤支镜活检、刷检细胞学误诊 2例。直接诊断为转移癌 3例。分别作了左全肺切除 1例 ,肺叶切除 11例 ,楔形切除 7例。结论　熟悉肺结核的病理改变 ,是减少误诊的基础。综合分析病史、症状、影像学等资料诊断仍困难时 ,经皮肺穿刺活检 ,可以最大限度地减少误诊误治。Objective To improve the accuracy in differentiating diagnosis between pulmonary tuberculosis and lung cancer.Methods Relevant cases during the past 4 years were reviewed.Lessons and know-hows in differentiating diagnosis were studied.Results Rate of misdiagnosis was 45.23%(19 of 42 cases),which accounted for 8.19%(19/232) of lung cancer operations during the same period.Of the 19 cases,14 cases were due to misjudgment by imaging analysis,2 cases by fiber optic bronchoscopy and cytology,and 3 cases by clinical diagnosis.Operations for these patients included total left pneumonectomy(1 case),lobectomy(11 cases),and wedge resection(7 cases).Conclusion Familiarity with image changes in pulmonary tuberculosis would be basically attributed to least misdiagnosis.In some cases hard to be confirmed even with combined evaluation regarding history,symptoms,imaging data,etc. percutaneous fine needle biopsy of the lung would greatly help in avoiding operations by mistake.

关 键 词：肺结核 诊断 肺癌 误治 影像学表现 

分 类 号：R521[医药卫生—内科学]