本文選題：結(jié)核　切入點：不典型　出處：《山東大學》2013年碩士論文

【摘要】：目的：總結(jié)分析不典型結(jié)核的臨床及影像學表現(xiàn),分析延誤診治或漏診的原因,探索合理的診斷方法。 方法：回顧性分析資料完整的10例經(jīng)病理學/細菌學檢查確診的不典型結(jié)核病例,并復習總結(jié)相關(guān)文獻資料。 結(jié)果：經(jīng)回顧分析近5年來不典型結(jié)核病例報告可以發(fā)現(xiàn),不典型結(jié)核誤診率達71.09%,可被誤診為近乎所有其它胸部疾病及多種其它系統(tǒng)疾病,在眾多疾病中不典型結(jié)核仍以被誤診為肺部腫瘤性疾病(36.85%)和肺炎(34.52%)最多見。造成不典型結(jié)核易被誤診的原因可概括為：(1)基礎(chǔ)疾病和合并癥的影響；(2)臨床表現(xiàn)不特異；(3)胸部影像學不典型；(4)病原學檢查陽性率低、實驗室檢查特異性低。為明確診斷需結(jié)合病原學檢查、纖維支氣管鏡檢查、CT或B超引導下經(jīng)皮肺穿刺活檢、內(nèi)科胸腔鏡甚至手術(shù)等多種手段。筆者接診的10例病例中有6例通過病理學檢查確診,近5年的文獻資料統(tǒng)計分析顯示經(jīng)病理學檢查確診者占64.01%,而且經(jīng)電子支氣管鏡病理、CT或B超引導下經(jīng)皮肺穿刺病理檢查確診的病例在總確診病例中所占比例分別為24.28%、26.74%,提示病理學檢查對于不典型結(jié)核的確診意義重大且通過電子支氣管鏡檢查及CT或B超引導下的經(jīng)皮肺穿刺活檢等創(chuàng)傷較小的方法取得病理已成為診斷不典型結(jié)核的重要方法之一。對于無病原學證據(jù)而又無法或者不愿行有創(chuàng)檢查的高度懷疑結(jié)核病的患者,可給予正規(guī)抗癆治療,并及時隨訪,對比觀察患者臨床表現(xiàn)及影像學變化,以正確做出診斷。 結(jié)論：不典型結(jié)核臨床癥狀及影像學表現(xiàn)多樣,同許多胸部疾病的臨床表現(xiàn)及影像學有相似之處,易相互誤診,在眾多疾病中不典型結(jié)核以被誤診為肺部腫瘤性疾病和肺炎最多見。為明確診斷需結(jié)合病原學檢查、纖維支氣管鏡檢查、CT或B超引導下經(jīng)皮肺穿刺活檢、內(nèi)科胸腔鏡甚至手術(shù)等多種手段,病理學檢查對于不典型結(jié)核的確診意義重大,而且通過電子支氣管鏡檢查及CT或B超引導下的經(jīng)皮肺穿刺活檢等創(chuàng)傷較小的方法取得病理已成為診斷不典型結(jié)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.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R52

【參考文獻】

相關(guān)期刊論文 前10條

1 曾祥麗;王紅梅;;59例不典型肺結(jié)核誤診原因分析[J];當代醫(yī)學;2011年10期

2 李基根;陳龍華;吳德華;;CT引導下經(jīng)皮肺穿刺活檢診斷疑難肺結(jié)核病的臨床應用(附15例臨床影像病理分析)[J];南方醫(yī)科大學學報;2006年02期

3 黃劍鋒,黃昌杰,湛永滋,王湘萍,李冬云;CT導向經(jīng)皮肺穿刺活檢的臨床應用[J];中國肺癌雜志;2002年01期

4 嚴振輝;;37例不典型肺結(jié)核影像學表現(xiàn)及誤診分析[J];廣東醫(yī)學院學報;2007年04期

5 許樹林;高云燕;梁玉潔;;X線表現(xiàn)不典型的肺結(jié)核誤診13例分析[J];臨床軍醫(yī)雜志;2008年05期

6 徐惠萍;許利凱;王曉聰;陳劍平;;不典型肺結(jié)核在綜合醫(yī)院的誤診分析[J];臨床肺科雜志;2007年11期

7 高媛;秦軍;;老年不典型肺結(jié)核的診斷分析[J];臨床肺科雜志;2008年03期

8 郇慶春;;36例成人不典型肺結(jié)核誤診分析[J];山東醫(yī)學高等�？茖W校學報;2009年04期

9 玉萍;尹淑芹;;3例不典型肺結(jié)核誤診原因分析[J];吉林醫(yī)學;2007年01期

10 白延東;;不典型肺結(jié)核誤診原因分析與對策[J];青海醫(yī)藥雜志;2008年01期

相關(guān)碩士學位論文 前1條

1 李靜靜;118例成人不典型肺結(jié)核的臨床分析[D];浙江大學;2009年

，

本文編號：1730293