162例表现为孤立性肺结节的肺癌延误诊治的临床分析  

Analysis of the delay diagnosis and treatment of lung cancer initially expressed as solitary pulmonary nodules diag- nosed by physical examination 162 cases report

作　　者：黄宇清[1] 杨德松[2] 刘彦国[2] 刘军[2] 王俊[2] 

机构地区：[1]北京市海淀医院胸外科,100080 [2]北京大学人民医院胸外科

出　　处：《中华胸心血管外科杂志》2012年第7期390-393,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：首都医学发展科研基金（20091017）;北京市海淀区科技项目（K0110099）

摘　　要：目的分析体检发现的以孤立性肺结节（SPN）为表现的肺癌患者延误治疗的情况和后果，探讨延误治疗的相关原因及改进方法。方法2000年1月至2011年8月，162例体检发现的SPN样肺癌患者，其中男93例，女69例；年龄33～82岁，平均（63．9±10．4）岁。按CT发现SPN到入院手术时间进行分组，其中〈1个月74例，1—3个月48例，≥3—6个月10例，≥6～12个月7例，≥12～24个月8例，924个月15例。分析从发现SPN到手术治疗时间延迟的影响因素，观察期间各组患者肿瘤直径的变化及病理分期分布。延误诊治原因按3方面归纳：患者因素（患者犹豫、未重视，治疗合并症延误），医师因素（误诊为炎症、结核、陈旧病变、良性肿瘤、转移瘤等），医院因素（入院前检查）。结果所有病例中，医师因素延误49例，占30．2％；患者因素延误50例，占30．9％；医院因素延误63例，占38．9％。医师因素延误中最常见为首诊炎症25例，其次为结核8例、陈旧病变8例。除外因治疗合并症及人院前检查等客观因素延误的患者，延误时间〈3个月者中，患者因素所致占63．2％（36／57例），40例≥3个月者主要是医师因素，占70．0％（28／40例），差异有统计学意义（，=10．338，P=0．001）。延误时间越长，肿瘤出现增大的可能越大，≥24个月及12～24个月者肿瘤增大比例分别为73．3％（11／15例）及87．5％（7／8例）。肿瘤分期Ⅳ期者比例延误时间〉124月、者达13．3％，其次为12—24个月者，达12．5％，绝对值明显高于其他各组。结论我国SPN样肺癌存在明显诊治延误，约1／3因医师误诊耽误。需提高医患对其重视程度，尽早手术确诊、治疗。Objective To analyze the delay in diagnosis and treatment lung cancer expressed as solitary pulmonary nod- ules （SPN） found by physical examination, and to discover the relative reasons and consequence for future improvement. Methods From January 2000 to August 201l, 162 patients （93 males, 69 females, ranging 33 - 82 years, median age 6319 years） with SPN found by physical examination and diagnosed lung cancer by surgical pathology subsequently were enrolled to this study. Depending on the interval between the date when finding SPN and the date of surgery, these cases were divided into 6 groups, including the group with interval less than 1 month （74 patients）, 1 -3 months （48 patients）, 3 -6 months （10 patients）, 6 -12 months （7 patients）, 12 -9~4 months （8 patients）, and more than 24 months （15 patients）. Factors which impact the delay interval between SNP finding and surgery were discussed. The change of tumor＇ s diameter during observation period, and the pathological characters were also analyzed among each group. Results Of all the delay eases, 30. 2% were attributed to doctors, 30.9% attributed to patients themselves, and 38.9% attributed to hospitals. 51.0% （25/49） of the ca- ses delayed by doctors were misdiagnosed as inflammation, 16.3% （8/49） misdiagnosed as tuberculosis, and 16. 3% （8/49） misdiagnosed as old lesions, which were three common reasons. Patients delayed more than 3 months were more likely to be related to doctor＇s misdiagnosis than those delayed less than 3 months [ 70. 0% （28/40） vs. 36. 8% （21/57） , X2 = 10. 338,P = 0. 001 ]. Moreover, the possibility of SPN enlargement was positively correlated with the delay interval. In groups with delay interval more than 24 months or between 12 and 24 months, the percentage of SPN enlargement were 73.3% （ 11/15 ） and 87.5% （7/8） separately. The proportion of patients with stage IV disease in groups whose delay interval exceeded 12 months （ 13.3% for more than 24 months and 12.5% for

关 键 词：肺肿瘤 肺结节 孤立性 误诊 肺外科手术 

分 类 号：R734.2[医药卫生—肿瘤]