鼻咽癌19例的误诊误治原因分析

Statistical analysis of the causes of erroneous diagnosis of nasopharyngeal carcinoma

目的探讨鼻咽癌的误诊原因,从中吸取经验教训,减少误诊,提高诊断符合率。方法对19例鼻咽癌误诊的临床资料进行综合分析,并讨论其误诊原因及防范措施。结果 19例中,男13例,女6例,年龄20～51岁,平均40.3岁。误诊时间:1～11个月,确诊前就诊次数2～5次,误诊疾病主要有:颈部淋巴结炎及淋巴结核9例(47.4%),分泌性中耳炎6例(31.6%),鼻咽纤维血管瘤2例(10.5%),腺样体残留1例(5.3%),血管神经性头痛1例(5.3%)。误诊病例病理诊断主要为低分化癌15例(78.9%),未分化癌3例(15.8%),腺样囊性癌1例(5.3%)。结论该病误诊的主要原因为医源性误诊,占84.2%,其次为患者自误,占15.8%。因此,临床各科医师都应提高对鼻咽癌的认识,特别是耳鼻咽喉科医师,更应从中吸取经验教训,减少误诊,提高早期诊断率和治愈率。

Objective To study the causes of erroneous diagnosis of nasopharyngeal carcinoma in order to decrease erroneous diagnosis, draw a lesson and improve diagnostic accuraney. Methods Statistical analysis on clinical material （19 eases） of erroneous diagnosis of nasopharyngeal carcinoma; Studying the cause of erroneous diagnosis and the method of prevention. Results 19 eases were from 20 to 51 years 01d, male 13 eases, female 6 cases. Misdiagnosis time ： 1 to 11 months. Misdiagnosis Views were 2 to 5. Misdiagnosed diseases were cervical adenitis and Cervical lymphatic with 9 cases （47.4%） , secretory otitis media with 6 cases （31.6%）, angiofibroma of nasopharynx with 2 cases （10. 5% ） , adenoid vegetation lasted with 1 cases （5.3%） , angioneurotie headache with 1 eases （5.3%）. Major erroneous diagnosis of clincopathological features were poorly differentiated carcinoma with 15 cases （78.9%）, undifferentiated carcinoma with 3 cases （15.8%）. Condusion The first cause of erroneous diagnosis is iatrogenie reason （ 84. 2% ） ;The second cause is from patients （ 15.8 % ）. So we ought to enhance recognition for it in order to decrease erroneous diagnosis, draw a lesson, improve early diagnosis and cure rate.