252例原发性支气管癌医源性延误诊断分析

AN ANALYSIS OF IATROGENICALLY DELAYED DIAGNOSIS OF 252 CASES WITHPH PRIMARY PULMONARY CANCERS

对我院住院肺癌３９６例进行分析，发现未能及时确立诊断者３３３例，占总病例８４％，其中属于医源性延误者２５２例，占未能及时确立诊断病例的７５．７％。其主要原因是临床医师对肺癌缺乏警惕用性，只重视ｘ线胸片而不重视病者的症状和体征；痰液脱落细胞检查阳性率低；未能充分利用纤维支气管镜作为主要检查手段。为早期发现肺癌，减少延误，应充分运用纤维支气管镜和横断计算机分层片及核磁共振等检查手段；提高痰检阳性率，对４５岁以上经常痰血、咳嗽，有高度怀疑癌肿而未能用一般检查证实者，尽量手术治疗。

by analyzing the 396 pulmonary cancer cases hospitalized in our hospital,we found 84%(333 cases)of them had not had confirmed diagnosis in time. Furthermore, 252(75.7%)of the 333 unconfirmed cases were iatrogenically delayed.The chief reason for such mistakes was that the physicians were not careful enough about pulmonary cancers.They focused their diagnosis only on X-ray pictures and neglected the symptoms and clinical signs of the patients.They did not make full use of fibrobronchoscopy and the positive rate of exfoliative cell test of the sputum was low .In order to correctly diagnose early pulmonary cancers and avoid such a delay,great advantage should be taken of the fibrobronchoscopy as well as CT and/or MRI,and sputm tests for,positive rates are to be improved,esp.in those above 45 years of age with frequent coughs and bloody sputum. For those highly suspected of cancers but not confirmed by ordinary examinations, a surgical operation is usually recommended to avoid the existence of such cancers.