肺结核合并肺癌的临床特点及误诊原因分析

目的探讨肺结核与肺癌并存的临床特点,并分析肺结核合并肺癌误诊的原因,以便提高肺结核合并肺癌的早期诊断率。方法回顾性分析52例肺结核合并肺癌患者的临床表现及实验室检查、X线、CT等检查结果,同时分析诊断及误诊情况。结果全组52例肺结核合并肺癌患者中,≤2周确诊者5例(9.6%),≤2个月确诊者12例(23.1%),>2个月确诊者35例(67.3%)。误诊主要原因包括:1)37例患者因有明确的肺结核病史或痰结核菌检查阳性结果而确诊为肺结核,未仔细观察肺癌相关症状和进行排除肺癌检查,导致漏诊肺癌;2)10例患者因对肺结核合并肺癌的认识不足,未及时进行血清肺癌肿瘤标志物及细胞病理学检查,导致漏诊肺癌。结论肺结核合并肺癌诊断较为困难,肺癌症状易被肺结核症状所掩盖,易发生漏诊,临床医生应提高对肺结核合并肺癌的认识,以免延误治疗时机。     

原发性胆囊癌误诊分析

目的分析原发性胆囊癌误诊原因,探索有效的预防措施。方法我院1995年1月至2006年5月共收治原发性胆囊癌患者46例,对其临床资料进行回顾性分析。结果术前明确诊断14例(占30.4%)。误诊32例(占69.6%),术中误诊6例(占13.0%)。合并胆囊结石者18例(占39.1%),胆囊息肉样病变8例(占17.4%)。术前诊断为胆囊结石、胆囊炎21例(占45.7%)。超声检查阳性率43.5%,CT检查阳性率66.7%,螺旋CT增强检查阳性率83.3%。结论误诊原因并发胆囊其它疾病;缺乏特异性临床表现,对发病情况认识不足;过分依赖影像学检查;术中对可疑病灶未做冰冻病理检查。预防措施熟悉胆囊癌的临床特点;可疑病例术前需完善检查;积极手术治疗癌前病变;术中可疑病灶应做冰冻病理检查。     

肺结核、肺癌并存30例误诊分析

目的分析肺结核、肺癌并存30例误诊原因.方法通过对30例误诊的肺结核合并肺癌临床资料进行回顾性分析.结果发现18例原有肺结核病史者,其中13例因痰菌、PCR、结核菌素试验阳性且既往有结核病史即诊为肺结核入院.以正规抗结核治疗,因症状缓解后复发或进行性恶化,而进一步经胸水细胞学检查、痰细胞学检查及影像学检查诊断合并肺癌.另5例经手术后证实.12例经痰细胞学检查,胸CT检查诊断为肺癌入内科治疗,因症状无缓解,行结核病检查(痰菌、PCR、结核菌素试验),确诊合并肺结核.结论临床医师应提高对肺结核、肺癌并存认识,及时诊断,避免延误治疗.     

贲门癌870例误诊相关因素分析

目的 通过对870例被延误诊断的贲门癌患者诊断过程进行统计分析,探讨造成贲门癌延误诊断的因素.方法 收集946例贲门癌病例,以首发症状出现1个月内未确诊者划为延误诊断病例,从年龄、性别、职业、家庭收入、首发症状(分为不伴有吞咽障碍类型与伴有吞咽障碍类型)与延误诊断情况方面进行分析统计.结果 总的延误诊断贲门癌患者为870例,占91.97%;主观延误548例,占63%;年龄方面:50岁以下延误诊断比例大于50岁以上.性别方面:男781例,女165例.女性延误诊断比例大于男性.职业方面:农民、工人、商人及其他人员受高中以上文化程度为37.7%,共766例,其中有736例延误诊断,高于知识分子、干部.家庭收入方面:中低收入共740例,有718例延误诊断.客观延误322例,发生于县、乡、社区诊所291例.结论 贲门癌延误诊断的原因是一个多层面、多因素、复杂的过程.加强防癌知识宣传,提高全民认识,特别是提高县、乡、社区诊所医务人员对贲门癌症状多变性认识,避免草率诊断,加强警觉性、责任心,对降低贲门癌延误诊断有重要意义.     

腹腔镜胆囊切除术意外胆囊癌四例

目的 增加对腹腔镜胆囊切除(LC)术中意外胆囊癌(UGC)的诊断认识,探讨避免在LC术中胆囊癌漏诊的方法.方法 回顾性分析4例LC术UGC的临床资料,并对其行B型超声、CT、MRI和磁共振胰胆管成像(MRCP)等影像学检查结果作出评价,分析漏误诊原因.结果 4例均漏诊,1例术后确诊并二次行开腹手术,其余3例患者家属不同意二次手术.漏误诊的主要原因为:胆囊癌本身症状隐匿、影像学检查的局限及腹腔镜手术方式的限制;对胆囊癌及胆囊癌高危人群的认识不足,LC术中对胆囊的观察粗疏,未仔细观察切除的胆囊标本.结论 应提高对LC术时胆囊癌的诊断意识和鉴别诊断能力,努力减少LC术时胆囊癌的漏诊.     

腹腔镜胆囊切除术意外胆囊癌四例

目的 增加对腹腔镜胆囊切除(LC)术中意外胆囊癌(UGC)的诊断认识,探讨避免在LC术中胆囊癌漏诊的方法.方法 回顾性分析4例LC术UGC的临床资料,并对其行B型超声、CT、MRI和磁共振胰胆管成像(MRCP)等影像学检查结果作出评价,分析漏误诊原因.结果 4例均漏诊,1例术后确诊并二次行开腹手术,其余3例患者家属不同意二次手术.漏误诊的主要原因为:胆囊癌本身症状隐匿、影像学检查的局限及腹腔镜手术方式的限制;对胆囊癌及胆囊癌高危人群的认识不足,LC术中对胆囊的观察粗疏,未仔细观察切除的胆囊标本.结论 应提高对LC术时胆囊癌的诊断意识和鉴别诊断能力,努力减少LC术时胆囊癌的漏诊.     

以肺外表现为首发症状的肺癌32例临床分析

目的 :研究以肺外表现为首发症状的肺癌的延误诊断状况及误诊原因。方法 :回顾性分析我院近 10年来有病理或细胞学诊断的 2 0 4例肺癌病人的临床资料。结果 :32例以肺外表现为首发症状的肺癌病人均被误诊。结论 :提高对肺癌的认识和警惕性是减少误诊的重要措施。     

鼻咽癌误诊、鉴别诊断及其早期发现

鼻咽癌发生于隐蔽的解剖部位,早期无症状,易延误诊断;一旦有了症状,病人对症状的忽视、没有及时就诊、接诊医师对鼻咽癌的症状和体征认识不足等均可造成鼻咽癌的延误诊断。本文对鼻咽癌误诊原因,鉴别诊断及鼻咽癌的检查方法作一总结和介绍。     

蕈样霉菌病12例临床分析

目的通过对蕈样霉菌病12例临床分析, 避免误诊、漏诊, 提高诊断治疗水平。方法 对2007年-2008年我院诊治的病人加以分析总结。结果 易延误诊断, 误诊原因为对本病认识不清, 缺乏临床经验, 询问病史不详细, 检查不仔细。结论 避免误诊、漏诊, 应做到掌握本病的特殊性, 详细询问病史, 检查应仔细, 尽早多次病理检查, 加强有关专业知识的学习。     

CT仿真喉镜对喉肿瘤的临床诊断价值

目的探讨CT仿真喉镜对喉肿瘤的诊断价值.方法对5名健康者、19例喉癌、5例声带及披裂息肉、4例乳头状瘤共33例患者,行螺旋CT扫描后经软件处理获得CT仿真喉镜图像,所有病例均与纤维喉镜和手术所见对照分析.结果CT仿真内镜显示喉内正常解剖结构与纤维喉镜一致;对喉肿瘤诊断敏感性为72.7%;显示病变范围优于纤维喉镜;对较小病变形态显示略差于纤维喉镜.结论CT仿真喉镜(以下简称CTVL)是纤维喉镜的很好补充手段,具有发展潜力.     

Improved detection of recurrent laryngeal tumor after radiotherapy using FDG-PET as initial method

BACKGROUND AND PURPOSE: Timely detection of recurrent laryngeal tumor after radiation is an important predictive factor for curation as well as preservation of laryngeal function. Direct laryngoscopy under general anesthesia with taking of biopsies is the standard diagnostic procedure to detect recurrence when suspicion is raised. This, however, is an invasive and potentially damaging technique. Hence, a non-invasive diagnostic procedure, such as (18)FDG-PET to stratify patients for direct laryngoscopy could be useful. (18)FDG-PET is interpreted visually so that observer variation may affect clinical practice. In the present study, we therefore investigated this aspect of reproducibility. PATIENTS AND METHODS: Thirty consecutive patients suspected of recurrent laryngeal carcinoma after radiotherapy underwent (18)FDG-PET and direct laryngoscopy under general anesthesia with taking of biopsies. (18)FDG-PET scans were reported by nine nuclear medicine physicians and residents, using a three-point scaling system. The reference was the absence or appearance of a local recurrence in the 12 months following (18)FDG-PET. RESULTS: Eight patients had biopsy proven recurrent laryngeal carcinoma. Sensitivity of (18)FDG-PET was 88% (95% CI 53-98%) and specificity was 82% (95% CI 62-93%). The observers had a moderate to reasonable agreement (weighted kappa 0.45 (95% CI 0.20-0.69)) vs. the clinical gold standard and interobserver kappa was 0.54 (95% CI 0.40-0.69). CONCLUSION: (18)FDG-PET seems to be a promising technique to detect recurrent laryngeal carcinoma after radiotherapy, and selecting patients for direct laryngoscopy. This will avoid futile invasive procedures. Interobserver agreement and variability is reasonable using this technique, but training is necessary. Studies comparing different strategies to select patients for direct laryngoscopy in case of suspected recurrence are warranted.     

下咽癌侵犯喉结构的 CT 评价

目的：评估下咽癌侵犯喉结构（ 包括声门旁间隙、会厌前间隙、杓会厌襞、甲状软骨、环状软骨及杓状软骨） 的 Ｃ Ｔ 诊断价值。方法：对２１ 例下咽癌的 Ｃ Ｔ 扫描与病理检查结果进行对比分析,以确定其准确性,并同喉镜检查＋ 喉侧位片进行比较。结果： Ｃ Ｔ 对于判断下咽癌侵犯喉结构的准确率远较喉镜检查＋ 喉侧位片高,假阳性及假阴性结果较少,优势明显。结论：应将 Ｃ Ｔ 扫描纳入下咽癌常规临床检查。     

Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the united states during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study

BACKGROUND: The American College of Surgeons Commission on Cancer (CoC) has conducted national Patient Care Evaluation (PCE) studies since 1976. METHODS: Over 1500 hospitals with CoC-approved cancer programs were invited to participate in this prospective cohort study of U.S. thyroid carcinoma cases treated in 1996. Follow-up will be conducted through the National Cancer Data Base. RESULTS: Of the 5584 cases of thyroid carcinoma, 81% were papillary, 10% follicular, 3.6% Hürthle cell, 0.5% familial medullary, 2.7% sporadic medullary, and 1.7% undifferentiated/anaplastic. Demographics and suspected risk factors were analyzed. Fine-needle aspiration of the thyroid gland (53%) or a neck lymph node (7%), thyroid nuclear scan (39%), and ultrasound (38%) constituted the most frequently utilized diagnostic modalities. The vast majority of patients with differentiated thyroid carcinoma presented with American Joint Committee on Cancer Stage I and II disease and relatively small tumors. For all histologies, near-total or total thyroidectomy constituted the dominant surgical treatment. No lymph nodes were examined in a substantial proportion of cases. Residual tumor after the surgical event could be documented in 11% of cases, hypocalcemia in 10% of cases, and recurrent laryngeal nerve injury in 1.3% of cases. Complications were most frequently associated with total thyroidectomy combined with lymph node dissection. Thirty-day mortality was 0.3%; when undifferentiated/anaplastic cancer cases were eliminated, it decreased to 0.2%. Adjuvant treatment, probably underreported in this study, consisted of hormonal suppression (50% overall) and radioiodine (50% overall). CONCLUSIONS: In addition to offering information concerning risk factors and symptoms, the current PCE study compliments the survival information from previous NCDB reports and offers a surveillance snapshot of current management of thyroid carcinoma in the U.S. Identified opportunities for improvement of care include 1) more frequent use of fine-needle aspiration cytology in making a diagnosis; 2) more frequent use of laryngoscopy in evaluating patients preoperatively, especially those with voice change; and 3) improved lymph node resection and analysis to improve staging and, in some situations, outcomes.     

不同分化程度喉癌组织中bcl-2和p53的表达及其相互关系

目的 :探讨喉癌中抗凋亡基因bcl 2和突变型 p5 3的表达、相互关系及在喉癌发生机制中的作用。方法 :用免疫组化法对正常喉组织 2 7例和喉良性肿瘤 11例进行突变型 p5 3的检测 ,对喉癌 5 2例标本进行bcl 2与突变型p5 3的检测。结果 :正常喉组织突变型 p5 3免疫组化阳性检出率为 14 8% ( 4 /2 7) ,喉良性肿瘤为 18 2 % ( 2 /11) ,喉癌为61 5 % ( 3 2 /5 2 ) ,三者间差异有统计学意义 ,P <0 0 5 ;其中低分化喉鳞癌阳性检出率为 84 6% ,中分化为 73 0 % ,高分化为 15 4% ,三者间差异有统计学意义 ,P <0 0 5 ;低分化喉鳞癌bcl 2免疫组化阳性检出率为 69 2 % ( 9/13 ) ,中分化为 3 8 5 % ( 10 /2 6) ,高分化为 2 3 1%( 3 /13 ) ,三者间差异无统计学意义 ,0 1>P >0 0 5 ;喉癌中 p5 3的表达与bcl 2的表达呈明显正相关 ,0 0 2 >P >0 0 1。结论 :p5 3基因突变可作为喉部良性肿瘤向恶性转化及恶性程度增高的一个标志 ,在喉癌的发生机制上抑制细胞凋亡的bcl 2与 p5 3基因有协同作用     

An extremely rare case of synchronous occurrence in the larynx of intravascular lymphoma and in situ squamous cell carcinoma

We present the first case of laryngeal intravascular lymphoma coexisting with in situ squamous cell carcinoma. The patient, a 53 years old man, presented with hoarseness starting a year ago and underwent laryngoscopy, which revealed two nodular lesions on his right vocal cord. The histological and immunohistochemical examination of the biopsy specimens established the diagnosis of in situ squamous cell carcinoma coexisting with intravascular lymphoma of T-cell origin. Taking in consideration all the available references, the larynx has not until now been reported as a primary site of involvement of intravascular (angiotropic) lymphomas, nor as a secondary location in the systematic course of this disease. Furthermore no cases have been reported in the literature, concerning the synchronous affection of the larynx by this lymphoma and in situ laryngeal carcinoma, or other type of neoplasm.     

Direct Laryngoscopy Using a Videogastroscope: Outcome of 119 Cases

Direct laryngoscopy is an essential examination for supraglottic and laryngeal pathology. Fibreoptic or videolaryngoscope are not readily available. This study was designed to see the usefulness of Videogastroscope to evaluate laryngeal lesion instead of fibreoptic or videolaryngoscope. Patients with unsuccessful or unsatisfactory indirect laryngoscopic examination referred by ENT surgeons were examined using videogastroscope and anaesthetizing oropharynx and hypopharynx with lidocaine pharyngeal spray. Under direct supervision impressions including still and dynamic images were recorded. Study group comprised of 76 males and 43 females with age varying from 09 to 87 with mean age 44 years. Various abnormalities were detected among 74 (62.2 %) patients. Common pathologies were vocal cord polyps and nodules in 28, laryngitis and laryngeal ulcer in 16, supraglottic growth in 13 and pyriform fossa growth in 10. Direct laryngoscopy using videogastroscope is safe, effective and easily performed newer technique which might be very useful where indirect laryngoscopy is difficult and fibreoptic or videolaryngoscope is not available.     

螺旋CT在喉及下咽癌的临床应用价值

目的 探讨螺旋ＣＴ多平面重组（ＭＰＲ）、三维重建（3D）和领导 具喉镜（CTVL）在喉及下咽癌的临床应用价值。方法 24例喉及下咽癌患者进行轴位螺旋CT扫描。同时做MPR、3D和CTVL成像,并与纤维喉镜和手术所见进行对照分析。结果 螺旋CT轴位结合MPR图像对术前肿瘤分期和诊断颈部淋巴结转移的准确性均为96%;25%的患者MPR显示肿瘤侵犯的范围优于轴位,3D重建可立体显示肿瘤的侵犯范围及其与血管、气管的关系;头端CTVL显示的喉及下咽部腔内肿瘤的部位、大小及侵犯范围与纤维喉镜所见相似,4例从足侧观察肿瘤与声带和前联合的关系弥补了纤维喉镜的不足,结论 螺旋CT轴位结合MPR、3D和CTVL图像可以更完整地提高喉及下咽癌的全面资料。     

以手术为主与以放疗为主治疗Ⅲ、Ⅳ期喉癌的疗效比较

目的 对比以手术为主和以放疗为主综合治疗方法在Ⅲ、Ⅳ期喉癌治疗中的疗效,探索Ⅲ、Ⅳ期喉癌合理的治疗方法.方法 回顾性分析Ⅲ、Ⅳ期喉癌103例(Ⅲ期39例,Ⅳ期64例)的临床资料.根据治疗方法分为手术±放疗组(S±R组,46例)和放疗或放化疗±挽救手术组(R±S组,57例).分析对比两组的总生存(OS)率、无复发生存(RFS)率和喉保留率.多因素分析影响Ⅲ、Ⅳ期喉癌患者生存率和喉保留率的独立因素.结果 S±R组2年OS率、RFS率分别为74.7％(34/46)、72.4％(33/46),优于R±S组的46.4％(26/57)、40.9％(23/57)(P＜0.05).R±S组的喉保留率高于S±R组[32.6％(15/46)比93.0％(53/57),P＜ 0.05].影响预后的独立因素为治疗方法和T分期,影响喉保留率的独立因素为治疗方法.结论 手术±放疗治疗Ⅲ、Ⅳ期喉癌的生存率优于放疗或放化疗±挽救手术,而前者喉保留率则低于后者.Ⅲ、Ⅳ期喉癌应以手术±放疗为首选治疗方法,生活质量的改善宜通过喉功能保留手术和发音重建的方法来实现.     

声门上型喉鳞癌94例临床特征及预后分析

目的:总结声门上型喉癌的临床特征,分析其预后的影响因素.方法:声门上型喉鳞癌94例.Kaplan-meier曲线行生存分析,Cox回归模型行多因素分析.结果:声门上型喉癌首发症状以声嘶最常见(47例,50.0%),其他依次为咽部不适(30例,31.9%)、颈部肿物(15例,16.0%),呼吸困难(2例,0.2%).初诊...     

暴露颈喉返神经在食管癌颈部吻合中的临床意义

目的:探讨食管中下段癌切除后行左颈部食管胃颈部吻合,术中暴露喉返神经与不暴露喉返神经对比的应用价值。方法:选择2003年1 月至2009年4 月对237 例行左侧胸后外切口切除食管鳞癌,并行左颈部切口食管、胃颈部吻合。总计237 例分成2 组:A 组（研究组）115 例,均暴露喉返神经,男64例,女51例,年龄31～73岁,平均年龄49岁;B 组（对照组）122 例,男51例,女71例,年龄33～75岁,平均年龄45岁,本组均不暴露喉返神经。两组共有9 例出现喉返神经损伤症状。结果:A 组术后出现发音嘶哑,饮水咳呛,咳痰效果差1 例,占手术发生率0.087%（1/115）,B 组出现发音嘶哑,咳呛,咳痰效果差8 例,占手术发生率6.56% 。两组喉返神经损伤差异具有显著性统计学意义（P<0.05）。 对两组食管癌切除,左颈食管吻合术时与两组对比,A 组暴露喉返神经可使术后颈喉返神经损伤率明显低于B 组不暴露喉返神经,可避免喉返神经损伤并发症,减少发音困难,减少进食咳呛,使咳痰效果佳而减少肺部并发症,能使患者早日康复。结论:本研究提示食管胃左颈吻合暴露喉返神经具有临床应用价值,值得推广。