CAJ | 학술논문

目的：探讨肺结核误漏诊的原因和防范措施。方法回顾性分析我院2005年1月—2013年12月收治138例肺结核误漏诊的临床资料。结果本组病程1周~3年,表现为长期慢性咳嗽、痰中带血、咯血、呼吸困难、消瘦、发热、盗汗等。均行胸部X线检查仅发现肺部病灶14例；46例行胸部CT检查示肺部感染29例；59例行痰抗酸杆菌检查均阴性；98例及时行结核菌素纯蛋白衍生物试验示弱阳性3例。本组误诊为肺炎及胸膜炎53例(38.4%)、慢性支气管炎15例(10.9%)、上呼吸道感染14例(10.1%)、支气管扩张症11例(8.0%)、肺癌6例(4.3%)；漏诊39例(28.3%)。误漏诊发生于三级医院14例(10.1%),二级医院40例(29.0%),社区医疗单位及防疫站84例(60．9%)。本组86例获病理诊断依据确诊,27例经诊断性抗结核治疗有效确诊,25例根据临床表现及医技检查结果确诊。诊断分型：浸润型肺结核98例(71.0%),浸润型肺结核合并结核性胸膜炎23例(16.7%),血行播散型肺结核12例(8.7%),纤维空洞型肺结核5例(3.6%)。结论肺结核因缺乏特异性临床表现、合并症掩盖病情、医技检查结果误导、工作人员经验或医疗条件不足、诊断性治疗出现反结果干扰临床诊断等原因而易发生误漏诊,详细采集病史资料、综合分析病情、仔细鉴别诊断是避免肺结核误漏诊的关键。
목적：탐토폐결핵오루진적원인화방범조시。방법회고성분석아원2005년1월—2013년12월수치138례폐결핵오루진적림상자료。결과본조병정1주~3년,표현위장기만성해수、담중대혈、각혈、호흡곤난、소수、발열、도한등。균행흉부X선검사부발현폐부병조14례；46례행흉부CT검사시폐부감염29례；59례행담항산간균검사균음성；98례급시행결핵균소순단백연생물시험시약양성3례。본조오진위폐염급흉막염53례(38.4%)、만성지기관염15례(10.9%)、상호흡도감염14례(10.1%)、지기관확장증11례(8.0%)、폐암6례(4.3%)；루진39례(28.3%)。오루진발생우삼급의원14례(10.1%),이급의원40례(29.0%),사구의료단위급방역참84례(60．9%)。본조86례획병리진단의거학진,27례경진단성항결핵치료유효학진,25례근거림상표현급의기검사결과학진。진단분형：침윤형폐결핵98례(71.0%),침윤형폐결핵합병결핵성흉막염23례(16.7%),혈행파산형폐결핵12례(8.7%),섬유공동형폐결핵5례(3.6%)。결론폐결핵인결핍특이성림상표현、합병증엄개병정、의기검사결과오도、공작인원경험혹의료조건불족、진단성치료출현반결과간우림상진단등원인이역발생오루진,상세채집병사자료、종합분석병정、자세감별진단시피면폐결핵오루진적관건。
Objective To discuss the causes and preventive measures of misdiagnosis and missed diagnosis of tuber-culosis. Methods Clinical data of 138 cases of tuberculosis patients misdiagnosed and missed-diagnosed and admitted to our hospital during January 2005 and December 2013 were retrospectively analyzed. Results The pathologic cycle was from 1 week to 3 years, characterized by chronic cough, blood in phlegm, hemoptysis, dyspnea, marasmus, fever and night sweats. All patients underwent thoracic roentgenoscopy, and only 14 cases had problems in the lungs;46 cases underwent the chest CT examination and there were 29 cases with pulmonary infection; 59 cases underwent acid-fast bacilli examination and all were negative;98 cases underwent purified protein derivative test and 3 cases turned to be weakly positive. In these cases, 53 cases were misdiagnosed as pneumonia and pleuritis(accounting for 38. 4%), 15 cases were chronic bronchitis (accounting for 10. 9%), 14 cases were upper respiratory infection (accounting for 10. 1%), 11 cases were bronchiectasis disease (ac-counting for 8. 0%), 6 cases were lung cancer (accounting for 4. 3%), 39 cases were missed-diagnosed (accounting for 28. 3%);there were 14 cases in tertiary hospitals (accounting for 10. 1%), 40 cases in secondary hospitals (accounting for 29. 0%), 84 cases in community hospitals and epidemic diseases prevention stations (accounting for 60. 9%). Among them, 86 cases were confirmed by pathological diagnosis;25 cases were diagnosed according to the clinical, iconography and labora-tory examinations;27 cases were confirmed by diagnostic treatment. Diagnostic analysis:98 cases were infiltrative pulmonary tuberculosis (accounting for 71. 0%), 23 cases were infiltrative pulmonary tuberculosis with tuberculous pleurisy (accounting for 16. 7%), 12 cases were hematogenous disseminated pulmonary tuberculosis (accounting for 8. 7%), 5 cases were fibro-cogitative pulmonary tuberculosis (accounting for 3. 6%). Conclusion Due to the lack of specific clinical manifestations, the illness being covered by complications, misleading auxiliary examinations, the lack of experience or poor equipment and diagnostic treatment turning out opposite results, tuberculosis is prone to be misdiagnosed and missed-diagnosed. To collect detailed medical record data, analyze the illness comprehensively and differentiate diagnosis carefully are crucial in avoiding misdiagnosing and missed diagnosing of tuberculosis.