临床误诊误治2023，Vol.36Issue(10) ：31-35.DOI:10.3969/j.issn.1002-3429.2023.10.008

中心型肺癌临床特点及误诊原因分析

Clinical Characteristics and Causes of Misdiagnosis of Central Lung Cancer

吕迪 张曙光
临床误诊误治2023，Vol.36Issue(10) ：31-35.DOI:10.3969/j.issn.1002-3429.2023.10.008
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  • 维普
  • 万方数据

中心型肺癌临床特点及误诊原因分析

Clinical Characteristics and Causes of Misdiagnosis of Central Lung Cancer

吕迪 1张曙光2
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作者信息

  • 1. 066000 河北 秦皇岛,北京大学第三医院秦皇岛医院普外科
  • 2. 063500 河北 滦南,滦南县医院普外科
  • 折叠

摘要

目的 分析中心型肺癌的临床特点及误诊原因.方法 回顾性分析 2018 年 1 月—2022 年 12 月收治的曾误诊的中心型肺癌21 例的临床资料.结果 21 例中有结核病史 9 例.18 例低热,15 例咳嗽、咳痰,3 例胸闷,2例胸痛,1 例咯血,9 例全身疼痛.颈部或腋窝可触及增大淋巴结6 例.血白细胞计数升高16 例,癌胚抗原升高3 例.初步诊断为肺浸润型结核和肺炎各9 例、纵隔肿瘤3 例.21 例经纤维支气管镜病理检查确诊为中心型肺癌,其中鳞状细胞癌12 例、小细胞未分化癌5 例、腺癌4 例.中位误诊时间32 d.确诊后15 例予放疗或化疗,6 例予手术切除联合放疗,随访6 个月因癌细胞转移致器官衰竭死亡6 例,15 例继续治疗中.结论 中心型肺癌早期表现不典型,易误诊为肺炎、肺结核、纵隔肿瘤等疾病;熟知其临床特征及影像学表现,提高对高危人群警惕性,必要时行纤维支气管镜活检和痰液细胞学等检查,认真鉴别诊断,或可避免误诊误治.

Abstract

Objective To analyze the clinical characteristics and causes of misdiagnosis of central lung cancer.Methods A retrospective analysis was conducted on the clinical data of 21 patients with misdiagnosed central lung cancer who were treated from January 2018 to December 2022.Results Among the 21 cases,there were 9 cases of tuberculosis.There were 18 cases with low fever,15 cases with cough and phlegm,3 cases with chest tightness,2 cases with chest pain,1 case with hemoptysis,and 9 cases with systemic pain.There were 6 cases of palpable enlarged lymph nodes in the neck or armpit.The white blood cell count increased in 16 cases,and carcinoembryonic antigen increased in 3 cases.Initial diagnosis included infiltrate pulmonary tuberculosis in 9 cases,pneumonia in 9 cases,and mediastinal tumor in 3 cases.Twenty-one ca-ses were diagnosed as central lung cancer through pathological examination of fiberoptic bronchoscopy,including 12 cases of squamous cell carcinoma,5 cases of small-cell undifferentiated carcinoma,and 4 cases of adenocarcinoma.The median dura-tion of misdiagnosis was 32 d.After diagnosis,15 cases received radiotherapy or chemotherapy,6 cases underwent surgical resection combined with radiotherapy,and 6 cases died of organ failure due to cancer cell metastasis during a six-month follow-up.Fifteen cases continued treatment without recurrence.Conclusion The early manifestations of central lung cancer are not typical,and it is easily misdiagnosed as pneumonia,tuberculosis,mediastinal tumor and other diseases.Clinicians should be familiar with its clinical features and imaging manifestations,enhance vigilance to high-risk groups,and perform fiberoptic bronchoscopy biopsy and sputum cytology examinations when necessary to carefully differentiate diagnosis,which may help avoid misdiagnosis and mistreatment.

关键词

中心型肺癌/鳞状细胞癌/误诊/肺炎/肺结核/纵隔肿瘤/纤维支气管镜/体层摄影术,螺旋计算机

Key words

Central lung cancer/Squamous cell carcinoma/Misdiagnosis/Pneumonia/Pulmonary tuberculosis/Me-diastinal tumors/Fiberoptic bronchoscopy/Tomography,spiral computed

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出版年

2023
临床误诊误治
解放军白求恩国际和平医院

临床误诊误治

CSTPCD
影响因子：0.914
ISSN：1002-3429
参考文献量26
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