肺结核误诊原因探讨

目的：分析肺结核误诊为肺部其他疾病的原因及确诊方法。方法：收集1998年1月至2002年12月期间我院收治的肺结核误诊为肺部其他疾病的病例64例，其中男41例，女23例，年龄16～67岁，平均年龄为43．9岁，对上述病例的误诊原因及确诊方法进行分析。结果：误诊为肺炎22例，误诊为肺癌26例，误诊为支气管扩张6例，误诊为败血症2例,误诊为伤寒1例，误诊为急性病毒性肝炎1例，误诊为金黄色葡萄球菌性肺炎1例,误诊为慢性肺脓疡5例。上述病例的确诊方法：痰内或纤维支气管镜肺灌洗液中找到抗酸杆菌20例，PPD强阳性、抗结核治疗获得疗效确诊5例．试验性抗结核治疗获得良好的临床疗效确诊9例，手术病理证实14例，经皮肺穿刺确诊9例，经动态观察确诊7例.结论：肺结核的临床诊断要结合临床病史、X线检查、痰抗酸杆菌的检查及PPD试验、结核抗体、经皮肺穿刺、纤维支气管镜检查情况进行综合分析判断,必要时可手术病理证实。

Analysis on reason for misdiagnosis of pulmonary tuberculosis

Objective: To analyse the reason for tuberculsis misdiagnosed as other diseases in lung and the diagnosis method. Method: Data of 64 cases with tuberculosis which were misdiagnosed as other diseases between January 1998 and December 2002 were collected. There were 41 men and 23 women. The age ranging from 16 to 67 year old (mean 43.9 year), To analyse the reason for misdiagnosis and diagnosis method. Result: The misdiagnosis cases were respectively pneumonia 22, lung cancer 26, bronchiectasis 6, septicaemia 2, typhoid 1, acute viral hepatitis 1, staphytococcus pneumonia 1 and chronic pulmonary abscess 5. The diagnosis methods were : Acid-fast bacillus was found in sputum or bronchoalveolar lavage fluid in 20, PPD strong positive and good results have achieved with anti-TB drugs in 5. Good clinical curative effect were achieved after testing anti-TB treatment in 9, and 14 cases were diagnosed from operating pathology , 9 cases were diagnosed from transcutaneous lung puncture, 7cases were diagnosed from observation.Conclusion: The clinican should to comprehensive analyse clinical history , X-ray examination , sputum anti-fast bacillus examination, PPD test, tuberculosis antibody, transcutaneous lung puncture and bronchofiberscope to diagnose pulmonary tuberculosis, and to confirm it from operation if necessary.