误诊为肿瘤的难治性肺炎41例临床分析

Clinical Analysis on 41 Cases of Refractory Pneumoni a Misdiagnosed as Tumor

目的总结难治性肺炎误诊为肺肿瘤的原因及经验、教训.方法对41例误诊为肺肿瘤的难治性肺炎患者的临床资料进行回顾性分析.结果本组41例患者开始均未经过系统检查、诊断,治疗用药也不规范,其中39例还反复应用过地塞米松.入院后经3～6次痰查癌细胞均为阴性,血CEA均在正常范围内.按难治性肺炎进行系统正规治疗后症状逐渐改善,1～2周后体温恢复正常,4～8周复查纤支镜均通畅,黏膜也渐恢复正常,有8例胸片有硬性病灶,仅1例病灶吸收不明显.结论有些基层医生对肺炎认识不足,致使一些病人漏诊或延误治疗或治疗不正规、不系统,导致肺炎转为慢性,甚至纤维组织增生而误为肺肿瘤才就诊.

Objective To sum up the causes of misdiagnosis as tumor of refractory pneumonia and its lessons. Methods Retrospective analysis was conducted according to the clinical data of 41 cases with refractory pneumonia misdiagnosed as tumor. Results All the 41 cases had experienced neither systematic examination nor canonical treatment at the beginning, and 39 of them had been administered with dexamethasone repeatedly. There was no positive finding in three to six times＇tumor cell examination in the sputa, and their blood CEA was in normal range. After having been treated as refractory pneumonia, their symptoms improved gradually, and the body temperature returned to normal in one or two weeks. Bronchia and their branches were expedite and bronchial mucosae recovered well, according to the bronchoscopy 4 - 8 weeks later, and there were eight cases showing hard focusi in the chest X-ray films. Only in one cases was the focus incompletely absorbed after one year. Conclusion Many patients are so misdi- agnosed and incorrectly treated due to some lower hospital＇s doctors exparte recognition to refractory pneumonia that the disease become chronic and is regarded as tumor because of its fibrous proliferation.