鼻咽结核误诊的原因分析及对策(附18例报告)

Analysis on misdiagnostic causes and countermeasures of nasopharyngeal tuberculosis (report of 18 cases)

目的探讨鼻咽结核的临床特征,分析误诊原因,减少误诊发生。方法回顾性分析近3年来18例误诊病例的临床资料。结果全组18例均系早期误诊,其中鼻咽癌13例,鼻咽纤维血管瘤1例,咽部恶性肉芽肿1例,鼻咽部慢性炎症3例。全部病例经正规抗结核药物治疗后痊愈。经6个月～2a随访无复发。结论鼻咽结核起病隐匿,对鼻咽部的任何可疑病灶均应详细询问病史,仔细体格检查,尽早进行活体组织学检查是减少误诊的关键。

[Objective] To investigate the clinical characteristics of nasopharyngeal tuberculosis and the causes for misdiagnosis in order to reduce the occurrence of misdiagnosis. [Methods] The clinical data of 18 cases with nasopharyngeal tuberculosis, who wcrc misdiagnosed in recent 3 years, were analyzed retrospectively. [Results] All cases with nasopharyngeal tuberculosis were misdiagnoscd during carl）＇ period. Of 18 cases, 13 were misdiagnosed as nasopharyngeal cancer, I as nasopharyngeal hcmal-fibroma, I as pharyngeal malignant gTanuloma. 3 as chronic hasopharyngeal inflammation. All the patients recovered through regular therapy using antitubercular agents without recurrence within foUow up of 6 months to 2 years. [Conclusions] Nasopharyngeal tuberculosis has no typical symptom and we should improve our comprehension about it. Any case with questionable focus in the nasopharynx must receive elaborate enquiry about medical history and careful physical examination. Early biopsy is the key to reduce the misdiagnosis rate.