中央型肺癌合并支气管结核漏诊临床报告并文献复习.docVIP

中央型肺癌合并支气管结核漏诊临床报告并文献复习 李莉娟 耿书军 刘晓飞 宋韬 解放军白求恩国际和平医院干部一科 河北省胸科医院结核内科 X 关注成功！ 加关注后您将方便地在 我的关注中得到本文献的被引频次变化的通知！ 新浪微博 腾讯微博 人人网 开心网 豆瓣网 网易微博 摘????要： 目的 探讨中央型肺癌合并支气管结核的临床特点及漏诊原因、防范措施。方法 对曾漏诊中央型肺癌的中央型肺癌合并支气管结核1例的临床资料进行回顾性分析。结果 患者因咳嗽、咳痰、胸闷及气短10年, 痰中带血5年, 加重1年入院。曾院外诊断肺结核, 予抗结核治疗6个月, 症状无明显改善, 遂就诊河北省胸科医院。入院后经数次痰病理、肿瘤标志物、痰抗酸染色、结核感染T细胞检测、结核菌素纯蛋白衍生物试验、胸部CT及支气管镜等检查, 诊断支气管结核, 给予抗结核治疗2个月患者症状好转, 复查胸部CT示病变吸收不明显。再次行支气管镜检查示左上叶固有支可见坏死组织较前减少, 坏死物下可见新生物;咬检组织病理检查示退变异性细胞伴大量坏死组织;刷检组织病理检查发现瘤细胞。诊断中央型肺癌合并支气管结核。转肿瘤科进一步治疗。给予放化疗辅助抗结核治疗后, 患者病情好转, 现生存状况良好, 定期行放化疗。结论 临床医师加强对病情及影像学检查结果分析细心程度, 提高业务技能, 不过度依赖医技检查结果, 并拓宽诊断思路, 可减少或避免中央型肺癌合并支气管结核漏诊。 关键词： 肺肿瘤; 结核; 支气管; 漏诊; 作者简介：宋韬, 电话E-mail:115305048@ 收稿日期：2017-08-05 Missed Diagnosis of Central Bronchogenic Carcinoma Combined with Bronchial Tuberculosis:a Case Report and Literature Review LI Li-juan GENG Shu-jun LIU Xiao-fei SONG Tao The First Department of Cadre Wards, Bethune International Peace Hospital of PLA; Department of Tuberculosis Medicine, Hebei Provincial Chest Hospital; Abstract： Objective To discuss clinical characteristics, causes and preventive measures of central bronchogenic carcinoma combined with bronchial tuberculosis. Methods Clinical data of 1 missed diagnosis patient with central bronchogenic carcinoma combined with bronchial tuberculosis was retrospectively analyzed. Results The patient was admitted cough, expectoration, dyspnea and shortness of breath for 10 years, bloody sputum for 5 years and aggravation for 1 year. The patient was diagnosed as having pulmonary tuberculosis in other hospital, and received anti tuberculosis treatment for 6 months, but the symptoms were not significantly improved, and then the patient visited Hebei Provincial Chest Hospital. After admission, the patient received examinations such as several times of sputum pathology, tumor marker, sputum acid fast staining, tuberculosis infectious T cells detection, purified protein derivative of tuberculin ( PPD) test, chest CT and bronc