鼻咽癌125例误诊原因分析

目的 探讨鼻咽癌误诊原因及其防范措施.方法 对2005年1月-2010年1月我院收治的125例鼻咽癌误诊病例职业构成及误诊疾病、科室、医院进行归纳总结.结果 本组占我院同期收治鼻咽癌55.1％(125/227).首发症状为颈部肿块55例,鼻部症状56例,耳部症状25例,眼部症状4例,其他症状24例(其中头痛18例).误诊为颈淋巴结炎46例,慢性鼻炎鼻窦炎31例,神经麻痹12例,偏头痛10例,分泌性中耳炎8例,鼻息肉6例,鼻出血原因待查5例,颈部淋巴结结核3例,鼻咽纤维瘤、青光眼、颌下肿瘤、三叉神经痛各1例.首诊在内外科和一级医院误诊率最高(67.2％和81.3％).51例误诊与不遵医行为有关,以农民患者居多.结论 基层医院及非耳鼻咽喉科医师要加强对鼻咽癌多种临床表现认识,对出现颈部肿块、头痛及耳部、眼部、口腔颌面部症状者,在排除本专科疾病后应考虑鼻咽癌,及时请专科医师会诊,并行鼻咽部活检病理检查,以早发现、早治疗.

Misdiagnosis Analysis of 125 Patients with Nasopharyngeal Carcinoma

Objective To analyze the misdiagnosis cause of the nasopharyngeal carcinoma in order to reduce the misdiagnosis rate.Methods The clinical data of 125 patients misdiagnosed as nasopharyngeal carcinoma during January 2005 and January 2010 in our hospital were analyzed for the patients’ occupational structures,misdiagnosed diseases,misdiagnosed departments and hospitals.Results The misdiagnosis rate was 55.1%(125/227),and the first symptoms included masses in neck(55 cases),nasal obstruction(56 cases),hearing loss or tinnitus(25 cases),eye symptoms(4 cases) and other symptoms(24 cases),including headache(18 cases),pharyngeal portion(1 case),toothache(1 case) and retral pain(1 case).Patients with nasopharyngeal carcinoma were misdiagnosed as cervical adenitis(46 cases),chronic rhinosinusitis(31 cases),nerve palsy(12 cases),migraine(10 cases),secretory otitis media(8 cases),nasal polyps(6 cases),rhinorrhagia of unknown reason(5 cases),tuberculosis of lymph nodes(3 cases),nasopharyngeal fibroma(1 case),glaucoma(1 case),neoplasms under jaw(1 case) and tic douloureux(1 case).The highest misdiagnosis rate of departments for the first visit occurred in medical and surgical departments and grass-root hospitals,which were 67.2% and 80.1% respectively.51 misdiagnosed cases(40.8%) were due to failure of following doctor’s advice and most of them were from rural areas.Conclusion Clinicians in grass-root hospitals and from the departments other than of otolaryngology should enhance understanding of the clinical manifestations of nasopharyngeal carcinoma.It is necessary for a patient with any one of the above symptoms to receive medical examinations such as a biopsy for the ear,nasopharynx and nose in order to confirm diagnosis of nasopharyngeal carcinoma.