骨化性气管支气管病并肺结核漏诊原因分析并文献复习  

Analysis of Missed Diagnosis Causes of Tracheobronchopathia Osteochondroplastica Complicated by Pulmonary Tuberculosis and a Literature Review

作　　者：曹仕鹏[1] 李春香[1] 李爱美[1] 刘超群[1] 

机构地区：[1]长沙市中心医院肺科医院三病室,长沙410004

出　　处：《临床误诊误治》2017年第6期18-21,共4页Clinical Misdiagnosis & Mistherapy

基　　金："十二五"国家科技重大专项课题(2013ZX10005004)

摘　　要：目的探讨骨化性气管支气管病(tracheobronchopathia osteochondroplastica,TO)并肺结核的临床特点及漏诊原因,提高诊治水平。方法对我院收治的TO并肺结核1例的临床资料进行回顾性分析。结果本例因反复咳嗽、咳痰1年半,加重伴胸痛1个月就诊。曾在外院就诊,诊断为气管支气管结核并肺结核,予抗结核及支气管镜下冷冻及局部注药治疗,症状未见缓解。入院后行结核菌素试验、结核抗体检查、胸部CT、支气管镜及活组织病理检查等,确诊为TO并右上肺结核,予抗结核及支气管镜下氩气刀治疗,患者症状好转出院。后继续抗结核治疗,定期复查,未见新发病灶。结论对高度怀疑TO的患者,及时行胸部高分辨率CT和支气管镜及多次多部位活组织病理检查是确诊的关键。Objective To investigate clinical characteristics and missed diagnosis causes of tracheobronchopathia os- teochondroplastica （TO） complicated by pulmonary tuberculosis （PTB） in order to improve levels of diagnosis and treatment. Methods Clinical data of 1 patient with TO complicated by PTB was retrospectively analyzed. Results The patient visited a doctor for repeated cough and expectoration for one and a half years, and aggravation associated by chest pain for 1 month. He had been diagnosed as having trachea-bronchus tuberculosis combined with pulmonary tuberculosis in other hospital, and was treated with anti-tuberculosis drugs and bronchoscopic cryotherapy and local drug injection, but his symptoms did not be re- lieved. He was confirmed the diagnosis of TO complicated by right upper pulmonary tuberculosis by tuberculin test, tuberculo- sis-antibody test, chest CT, bronchoscopy and biopsy pathological examinations in our hospital, and treatments of anti-tuber- culosis drugs and bronchoscopic argon ion laser were given, and then the patient discharged after his symptoms had improved. Anti-tuberculosis treatment was given continuously after discharge, and no new lesions were found by regularly review. Con- clusion It is the key to performing high-resolution chest CT test, bronchoscopy and multiple times and positions of biopsy pathological examinations in diagnosis of highly suspected TO patients.

关 键 词：骨化性气管支气管病 肺结核 漏诊 

分 类 号：R521[医药卫生—内科学] R562.2[医药卫生—临床医学]