喉结核误诊临床分析  

Clinical Analysis of Misdiagnosis of Laryngeal Tuberculosis

作　　者：魏峥 林远超[1] WEI Zheng;LIN Yuan-chao(Department of Otolaryngology,Bazhong Central Hospital,Bazhong,Sichuan 636000,China)

机构地区：[1]巴中市中心医院耳鼻喉科,四川巴中636000

出　　处：《临床误诊误治》2022年第9期1-4,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析喉结核的临床特点及发生误诊的原因,并总结防范误诊措施。方法回顾分析2019年4月—2020年8月收治11例喉结核的误诊病例资料。结果11例均以不同程度的咽喉症状首诊于耳鼻咽喉科,2例触及颈部增大淋巴结。2例行结核菌素纯化蛋白衍生物(PPD)试验及痰涂片抗酸杆菌均阴性。11例行喉镜检查示:喉黏膜慢性充血肥厚7例,溃疡4例,苍白、水肿4例,肉芽增生3例。初步诊断为喉癌2例、慢性喉炎3例、声带息肉6例。误诊时间14 d~1个月。误诊喉癌2例拟行手术治疗;误诊慢性喉炎3例予抗感染和声休治疗后效果不佳;误诊声带息肉6例拟行电子喉镜下声带息肉手术治疗。11例均经病理学检查确诊为喉结核。确诊后予系统性抗结核治疗,随访2年无复发。结论喉结核早期临床表现不典型,无特异性,当患者以咽喉部症状就诊,又无结核中毒全身症状时,若未及时行病理学检查极易误诊。应详细询问病史,仔细查体,认真鉴别诊断,及时行胸部X线、胸部CT、痰结核菌、PPD试验、喉镜等检查,必要时可行诊断性抗结核治疗及病理学检查,以及早明确诊断并治疗。Objective To analyze the clinical characteristics of laryngeal tuberculosis and the reasons for misdiagnosis,and to summarize the measures to prevent misdiagnosis.Methods The data of 11 misdiagnosed cases of laryngeal tuberculosis admitted from April 2019 to August 2020 were retrospectively analyzed.Results All 11 cases were initially diagnosed in the Department of Otolaryngology with varying degrees of throat symptoms,and 2 cases had enlarged lymph nodes in the neck.For 2 cases,routine tuberculin purified protein derivative(PPD)test and sputum smear for acid-fast bacilli were negative.Laryngoscopy in 11 cases showed 7 cases of chronic hyperemia and hypertrophy of laryngeal mucosa,4 cases of ulcer,4 cases of pallor and edema,and 3 cases of granulation hyperplasia.The initial diagnosis was 2 cases of laryngeal cancer,3 cases of chronic laryngitis,and 6 cases of vocal cord polyps.The duration of misdiagnosis was 14 d to 1 month.Two cases of misdiagnosed laryngeal cancer were planned to be treated by surgery;3 cases of misdiagnosed chronic laryngitis were treated with anti-infective therapy and voice rest and the effect was far from satisfactory;6 cases of misdiagnosed vocal cord polyps were planned to be surgically treated by electronic laryngoscope.All 11 cases were diagnosed as laryngeal tuberculosis by pathological examination.After the diagnosis,systemic anti-tuberculosis treatment was given,and there was no recurrence during the 2-year follow-up.Conclusion The early clinical manifestations of laryngeal tuberculosis are atypical and non-specific.When the patient seeks treatment with throat symptoms and without systemic symptoms of tuberculosis poisoning,it is more likely to be misdiagnosed if timely pathological examination is not carried out.Detailed medical history,careful physical examination,careful differential diagnosis,timely chest X-ray,chest CT,tuberculosis bacteria in sputum,PPD test,laryngoscopy and other examinations,diagnostic anti-tuberculosis treatment and pathological examination,if necessary,ar

关 键 词：结核 喉 误诊 喉肿瘤 急性喉炎 声带息肉 

分 类 号：R529.8[医药卫生—内科学]