成人不典型肺结核20例误漏诊分析

目的 分析成人不典型肺结核误漏诊原因并提出防范对策.方法 对我院2009年11月～ 2010年11月发生误漏诊的20例成人不典型肺结核的临床资料进行回顾性分析.结果 本组表现为发热、咳嗽、咳痰,误诊为肺炎13例,支气管炎2例,肺癌2例,漏诊3例.后经纤维支气管镜刷片、活检确诊7例,经皮肺穿刺活检确诊3例,痰集菌和结核菌素纯蛋白衍生物(PPD)试验(+++)各确诊3例,术后病理确诊2例,试验性抗结核治疗有效确诊2例,均予相应抗结核治疗症状缓解.结论 成人不典型肺结核误漏诊率高,临床应提高对本病的认识,及早行CT检查,必要时可结合纤维支气管镜、经皮肺穿刺活检等,以增加本病的检出率.

Analysis of Misdiagnosis of 20 Patients with Adult Atypical Tuberculosis

Objective To analyse the cause of misdiagnosis of adult atypical tuberculosis and propose countermeasures.Methods We retrospectively reviewed 20 cases of adult atypical tuberculosis misdiagnosed in our hospital during November 2009 and November 2010.Results The clinical manifestation of this group of patients included fever,cough,expectoration.Diagnostic errors was 13 cases of pneumonia,2 cases of bronchitis,2 cases of lung cancer and 3 cases were missed diagnosed,7 cases were definitly diagnosed by swear and biopsy of bronchofiborscopy;3 cases by percutaneous pulmonary puncture biopsy;3 cases by collecting sputum and finding acid-fast bacilli(AFB);3 cases were positive for purified protein derivative(PPD) test;2 cases were proved by pathology and operation,2 cases were valid for diagnostic antitubercular treatment.All the patients’ symptoms were relieved by anti-tuberculosis drugs.Conclusion The misdiagnosis rate of adult atypical tuberculosis is high.Early CT examination,fiberoptic bronchoscopy and percutaneous pulmonary puncture inspection are necessary in improving the detection rate.