不典型胸部结核10例报告并文献复习

发布时间：2018-04-10 07:40

本文选题：结核　切入点：不典型　出处：《山东大学》2013年硕士论文

【摘要】：目的：总结分析不典型结核的临床及影像学表现,分析延误诊治或漏诊的原因,探索合理的诊断方法。方法：回顾性分析资料完整的10例经病理学/细菌学检查确诊的不典型结核病例,并复习总结相关文献资料。结果：经回顾分析近5年来不典型结核病例报告可以发现,不典型结核误诊率达71.09%,可被误诊为近乎所有其它胸部疾病及多种其它系统疾病,在众多疾病中不典型结核仍以被误诊为肺部肿瘤性疾病(36.85%)和肺炎(34.52%)最多见。造成不典型结核易被误诊的原因可概括为：(1)基础疾病和合并症的影响；(2)临床表现不特异；(3)胸部影像学不典型；(4)病原学检查阳性率低、实验室检查特异性低。为明确诊断需结合病原学检查、纤维支气管镜检查、CT或B超引导下经皮肺穿刺活检、内科胸腔镜甚至手术等多种手段。笔者接诊的10例病例中有6例通过病理学检查确诊,近5年的文献资料统计分析显示经病理学检查确诊者占64.01%,而且经电子支气管镜病理、CT或B超引导下经皮肺穿刺病理检查确诊的病例在总确诊病例中所占比例分别为24.28%、26.74%,提示病理学检查对于不典型结核的确诊意义重大且通过电子支气管镜检查及CT或B超引导下的经皮肺穿刺活检等创伤较小的方法取得病理已成为诊断不典型结核的重要方法之一。对于无病原学证据而又无法或者不愿行有创检查的高度怀疑结核病的患者,可给予正规抗痨治疗,并及时随访,对比观察患者临床表现及影像学变化,以正确做出诊断。结论：不典型结核临床症状及影像学表现多样,同许多胸部疾病的临床表现及影像学有相似之处,易相互误诊,在众多疾病中不典型结核以被误诊为肺部肿瘤性疾病和肺炎最多见。为明确诊断需结合病原学检查、纤维支气管镜检查、CT或B超引导下经皮肺穿刺活检、内科胸腔镜甚至手术等多种手段,病理学检查对于不典型结核的确诊意义重大,而且通过电子支气管镜检查及CT或B超引导下的经皮肺穿刺活检等创伤较小的方法取得病理已成为诊断不典型结核的重要方法之一。
[Abstract]:Objective: to summarize and analyze the clinical and imaging manifestations of atypical tuberculosis, analyze the causes of delayed diagnosis or missed diagnosis, and explore a reasonable diagnostic method.Methods: ten cases of atypical tuberculosis diagnosed by pathology / bacteriology were retrospectively analyzed and the related literature was reviewed.Results: the misdiagnosis rate of atypical tuberculosis in recent 5 years was 71.09%, which could be misdiagnosed as almost all other chest diseases and many other systemic diseases.Atypical tuberculosis was still misdiagnosed as lung neoplastic disease (36.85) and pneumonia (34.52).The causes of misdiagnosis of atypical tuberculosis can be summarized as follows: 1) the influence of basic diseases and complications. 2) the clinical manifestation is not specific. 3) chest imaging is atypical. 4) the positive rate of etiological examination is low, and the specificity of laboratory examination is low.In order to confirm the diagnosis, we should combine the etiological examination, fiberoptic bronchoscopy, CT or B-ultrasound guided percutaneous lung biopsy, medical thoracoscopy and even surgery.Of the 10 cases, 6 were diagnosed by pathological examination.Statistical analysis of literature data in the past 5 years showed that 64.01 cases were diagnosed by pathological examination, and the proportion of cases confirmed by CT or B-ultrasound guided percutaneous lung biopsy in the total confirmed cases was different.This suggests that pathological examination is of great significance for the diagnosis of atypical tuberculosis and that the diagnosis of atypical tuberculosis has become atypical through electronic bronchoscopy and less invasive methods such as CT or B-ultrasound guided percutaneous lung biopsy.One of the important methods of tuberculosis.Patients with highly suspected tuberculosis who have no evidence of etiology and are unable or unwilling to undergo invasive examination can be treated with regular antituberculosis therapy and followed up in time to make a correct diagnosis by comparing the clinical manifestations and imaging changes of the patients.Conclusion: the clinical symptoms and imaging manifestations of atypical tuberculosis are various, which are similar to those of many chest diseases and are easy to misdiagnose each other.Atypical tuberculosis is most commonly misdiagnosed as lung neoplastic disease and pneumonia among many diseases.In order to confirm the diagnosis, we should combine the etiological examination, the fiberoptic bronchoscopy, the percutaneous lung biopsy under the guidance of CT or B-ultrasound, the medical thoracoscopy and even the operation and so on. The pathological examination is of great significance for the diagnosis of atypical tuberculosis.It has become one of the important methods to diagnose atypical tuberculosis by electronic bronchoscopy and percutaneous lung biopsy under the guidance of CT or B-ultrasound.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R52

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