肺癌临床误诊原因分析  

Analysis of the Causes of Clinical Misdiagnosis of Lung Cancer

作　　者：李诗子 程少麟[1] 张光辉 LI Shizi;CHENG Shaolin;ZHANG Guanghui(Department of Thoracic and Cardiac Surgery,the First People's Hospital of Bengbu City,Bengbu,Anhui 233000,China)

机构地区：[1]蚌埠市第一人民医院胸心外科,安徽蚌埠233000

出　　处：《临床误诊误治》2025年第6期17-21,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析肺癌的误诊原因及防范措施。方法回顾性分析2024年1至12月收治的曾误诊的2例肺癌患者的临床资料。结果1例因“咳嗽、潮热、盗汗4个月余”就诊,行胸部CT检查初步诊断为结核性胸膜炎,予抗结核药物治疗。患者症状加重,根据头胸腹部CT、肿瘤标志物检查、胸腔积液检查考虑肺癌伴全身多处转移可能性大。行CT引导下右肺穿刺,病理检查示右肺腺癌,临床诊断:肺癌伴两肺转移、骨转移。误诊时间4.5个月。确诊后予化疗、靶向治疗、胸腔穿刺引流及对症支持等治疗后出院,化疗6个周期,病情缓解。1例因咳嗽、咳痰,无痰中带血或发热,行胸部CT检查并检测血清癌胚抗原升高。初步诊断为社区获得性肺炎,给予抗生素治疗后症状缓解。3个月后,患者出现左胸背部隐痛,复查CT见左肺中央型占位,癌胚抗原升高。经CT引导下左肺穿刺病理确诊为左肺小细胞肺癌。误诊时间3.5个月。确诊后予化疗,病情得到控制,未见新病灶。结论肺癌临床症状常不典型,误诊率较高,对于经抗感染或抗结核治疗无效的肺炎或肺结核患者,应考虑肺癌可能,建议加强医生培训、优化诊断流程及引入先进检测手段,尽早明确诊断、积极治疗,以提高患者生存质量。Objective To analyze the causes of misdiagnosis and preventive measures of lung cancer.Methods The clinical data of 2 patients with previously misdiagnosed lung cancer admitted to our hospital from January to December 2024 were retrospectively analyzed.Results One patient was admitted due to cough,hot flashes and night sweats for more than 4 months,and was initially diagnosed as tuberculous pleurisy by chest CT examination and treated with anti-tuberculosis drugs.The patient's symptoms worsened.According to the head,chest and abdomen CT,tumor marker examination,and pleural effusion,the possibility of lung cancer with multiple metastases was considered.CT-guided puncture of the right lung was performed,and the pathological examination showed adenocarcinoma of the right lung.The clinical diagnosis was lung cancer with bilateral lung metastasis and bone metastasis.The misdiagnosis lasted 4.5 months.The patient was discharged after chemotherapy,targeted therapy,thoracic puncture drainage,symptomatic support and other treatments.The patient was relieved after 6 cycles of chemotherapy.Chest CT was performed in one patient because of cough and expectoration without blood in sputum or fever,and the increased serum carcinoembryonic antigen was detected.The initial diagnosis was community-acquired pneumonia,and the symptoms were relieved after antibiotic treatment.Three months afterwards,the patient developed dull pain in the left chest and back.Reexamination of CT showed a central mass in the left lung and elevated carcinoembryonic antigen.The diagnosis of small cell lung cancer in the left lung was confirmed by CT-guided biopsy.The misdiagnosis lasted 3.5 months.After diagnosis,chemotherapy was given,and the disease was controlled without new lesions.Conclusion The clinical symptoms of patients with lung cancer are often atypical,and the misdiagnosis rate is high.For patients with pneumonia or tuberculosis who have no response to anti-infection or anti-tuberculosis treatment,the possibility of lung cancer should be consi

关 键 词：肺肿瘤 误诊 社区获得性肺炎 结核 胸膜 结核菌素试验 癌胚抗原 病理诊断 抗肿瘤联合化疗方案 

分 类 号：R734.2[医药卫生—肿瘤]