左肺下叶中分化腺癌1例误诊分析  

Analysis of one case misdiagnosed of moderately differentiated adenocarcinoma in the left inferior lobe of the Lung

作　　者：郭杨 贾惠军 姚洁[1] 董博 杨锋[1] 刘芳[1] 李晓伟[1] 刘德玉 GUO Yang;JIA Huijun;YAO Jie;DONG Bo;YANG Feng;LIU Fang;LI Xiaowei;LIU Deyu(Shaanxi University of Chinese Medicine,Shaanxi Province,Xianyang712046,China;Fugu County Traditional Chinese Medicine Hospital,Shaanxi Province,Yulin719400,China;Department of Orthopedics,Affiliated Hospital of Shaanxi University of Chinese Medicine,Shaanxi Province,Xianyang712000,China)

机构地区：[1]陕西中医药大学,陕西咸阳712046 [2]陕西省榆林市府谷县中医医院,陕西榆林719400 [3]陕西中医药大学附属医院骨病科,陕西咸阳712000

出　　处：《中国医药导报》2020年第18期181-184,F0003,共5页China Medical Herald

基　　金：陕西省自然科学基础研究计划项目(2018JM7132);陕西省教育厅专项科研计划项目(18JK0226);陕西中医药大学学科创新团队建设项目(2019-YL02);陕西省高校青年创新团队(中医药防治骨关节疾病研究创新团队);刘德玉名老中医药专家传承工作室项目;关中李氏骨伤流派传承工作室项目;陕西省三秦学者创新团队支持计划项目。

摘　　要：肺癌是全球发病率、致死率最高的恶性肿瘤,其发病隐匿,早期症状不明显,临床常出现误诊漏诊,延误最佳治疗时机。本文通过1例首发症状为左肩关节疼痛误诊为左肱骨头缺血性坏死的病例结合国内外相关文献资料从其发病原因、影像学特点、病理组织特点及相似疾病的鉴别介绍该疾病。所选患者系因"左肩关节疼痛伴活动受限1周"于2019年5月30日入住陕西中医药大学附属医院,入院检查后考虑肿瘤性病变,周围型肺癌并肺内多发转移可能,术后病理检查诊断为左肺下叶中分化癌。患者首发症状与肺癌症状不相符,医生在收治患者时以固定思维模式诊治,未能发散思考,有效辨证,相关影像学征象不典型,从而导致误诊。本文旨在分析总结病例资料,为今后提高肺癌的诊断和治疗提供借鉴。Lung cancer is a malignant tumor with the highest incidence and mortality in the world.Its onset is insidious,early signs and symptoms are subtle,clinical misdiagnosis and missed diagnosis often occur,delaying the best time for treatment.In this paper,a case with the first symptom of left shoulder joint pain was misdiagnosed as ischemic necrosis of left humerus head.Combined with relevant literatures at home and abroad,this disease was introduced in terms of its pathogenesis,imaging characteristics,pathological tissue characteristics and the differentiation of similar diseases.The patient was admitted to Affiliated Hospital of Shaanxi University of Chinese Medicine on May 30,2019 due to“left shoulder pain with limited movement for one week”.The patient was considered as tumor lesions,peripheral lung cancer with possibility of multiple metastasis in the lungs.The postoperative pathology examination showed differentiatiated carcinoma in the left lower lobe.The first onset symptoms of the patient do not match the symptoms of lung cancer.The doctor diagnozed and treated the patient with a fixed thinking mode while failing to diverge thinking,effectively differentiate the symptoms.The related imaging signs are not typical,leading to misdiagnosis.The purpose of this paper is to analyzed and summarized the case and provide reference for improving the diagnosis and treatment of lung cancer in the future.

关 键 词：肱骨头缺血 左肺下叶 中分化 腺癌 

分 类 号：R734.2[医药卫生—肿瘤]