摘要
Abstract
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.关键词
结核,肺/误诊/漏诊/肺炎/支气管炎,慢性/呼吸道感染/支气管扩张症/肺肿瘤Key words
Tuberculosis, pulmonary/Misdiagnosis/Missed-diagnosis/Pneumonia/Bronchitis, chronic/Respirato-ry tract infection/Bronchiectasis/Lung neoplasm分类
医药卫生
