误诊为肺结核的42例细支气管肺泡癌患者临床分析

目的 探讨细支气管肺泡癌患者的临床特点、误诊原因及诊治经验。方法 2009年1月至2012年1月西安市结核病胸部肿瘤医院共收治各类肺结核患者22047例，最初误诊为肺结核而后证实为其他病变者203例，其中42例患者经病理组织学证实为细支气管肺泡癌；对42例误诊为肺结核的细支气管肺泡癌患者的临床病理资料进行回顾性分析。结果 细支气管肺泡癌的临床表现以咳嗽、咯痰（31例）、气短（23例）为主，其次为胸闷、胸痛（12例）、咯血或痰中带血（8例）；影像学可分为3类，其中33例为孤立结节型，4例为肺炎型，5例为弥漫结节型；42例患者确诊细支气管肺泡癌前均误诊为肺结核，其中误诊为浸润性肺结核23例，肺结核瘤11例，亚急性血行播散性肺结核5例，肺结核合并浆膜腔积液3例；抗结核治疗症状反复或影像学无明显变化，最终通过手术或肺穿刺证实为细支气管肺泡癌。其中Ⅰ期患者20例。42例患者除2例随访未达到1年而失访外，其余均随访满1年或随访至患者死亡。全组随访1年中1例患者死亡，全组随访1年生存率为97.50%（39/40）。结论 细支气管肺泡癌临床症状及影像学表现特异性不高，极易误诊为肺结核；应综合分析，提高早期诊断率。

Clinical analysis on 42 cases with bronchioloalveolar carcinoma misdiagnosised as pulmonary tuberculosis

Objective To study the clinical characteristic, the causes of misdiagnosis, diagnosis and treatment experience of bronchioloalveolar carcinoma. Methods From 2009 January to 2012 January, 203 cases who were initially misdiagnosed as pulmonary tuberculosis were diagnosed finally with other lung diseases among 22047 cases diagnosed with pulmonary tuberculosis in Xi’an Tuberculosis and Thoracic Tumor Hospital. Forty-two cases were confirmed as bronchioloalveolar carcinoma among 203 cases. A retrospective clinicopathologic analysis was conducted on these 42 patients. Results The typical clinical manifestations of bronchioloalveolar carcinoma were cough and expectoration, shortness of breath, chest pain and stuffinees. All patients were divided into 3 categorie accor-ding to imaging finding. Solitary nodular type 33 cases, pneumonia type 4 cases and diffuse nodular type 5 cases. Forty-two patients with bronchioloalveolar carcinoma were misdiagnosed as pulmonary tuberculosis, of which 23 were misdiagnosed as infiltrative pulmonary tuberculosis, pulmonary tuberculoma in 11 cases, 5 cases of subacute blood disseminated pulmonary tuberculosis and 3 cases of pulmonary tuberculosis complicated with serous cavity effusion. Symptoms were repeated and imaging were unimproved after anti-tuberculosis therapy. All cased were diagnosed finally with bronchioloalveolar carcinoma by pathological examination. Conclusion The clinical symptom and imaging manifestations of bronchioloalveolar carcinoma have its low specificity which is easily misdiagnosed as pulmonary tuberculosis. It should be comprehensive analysis to enhance the rate of early diagnosis.