单侧鼻腔鼻窦占位性病变的临床误诊分析

Research on misdiagnosis of space occupying lesions in unilateral nasal sinus

目的:通过对213例单侧鼻腔鼻窦占位性病变的回顾性分析,研究该类病变的临床诊断及其误诊情况,为临床医生对此类患者的诊断和治疗提供参考。方法:结合近年来相关文献,通过对213例单侧鼻腔鼻窦占位性病变患者的诊断及误诊资料作临床分析,对被误诊患者的临床表现、影像学检查、病理作回顾性研究。结果:213例患者中,鼻息肉65例,鼻窦囊肿66例,真菌性鼻窦炎20例,良性肿瘤31例,恶性肿瘤28例,鼻腔异物3例;左侧鼻腔鼻窦116例,右侧鼻腔鼻窦97例。误诊情况:213例中,将恶性肿瘤误诊为鼻息肉12例,误诊率5.63%;鼻腔异物误诊为鼻窦炎2例,误诊率0.94%;内翻性乳头状瘤误诊为鼻息肉6例,误诊率8.45%;真菌性鼻窦炎误诊为化脓性鼻窦炎5例,误诊率2.35%;鼻窦囊肿误诊为鼻窦炎8例,误诊率3.75%。结论:详询病史,仔细专科检查,包括鼻内镜、鼻窦三维CT、鼻窦三维MRI及活组织病理检查等对判断该类病变的部位和性质至关重要,有助于早期诊治,并减少误诊误治。

By nearly 3-year retrospectie analysis of cases with space-occupying lesions in unilateral nasal sinus in Guizhou Province People＇s Hospital, clinical diagnostic and misdiagnosis of such lesions were ex- plored to provide references for clinicians in diagnosis and treatment of such diseases, Method： Combining related literatures in recent years, 213 patients with space-occupying lesions in unilateral nasal sinus were .selected. The pa- tients misdiagnosed were reviewed for its clinical manifestations, of patients had been misdiagnosed, imaging fea- tures and and pathology. Result：Of 213 patients, 116 cases located in the left nasal sinus and 97 in right, 65 pa- tients were nasal polyps, 66 were sinus cyst, 20 were fungal sinusitis, 31 were benign tumor, 28 were malignant tumor and 3 were nasal foreign body. Misdiagnosis were as follow： 12 patients with malignant tumor were misdi- agnosed as nasal polyps and the misdiagnosis rate 5.63 ~. Nasal foreign bodies were misdiagnosed as sinusitis in 2 cases and the misdiagnosis rate 0.94}/0. Inerted papilloma misdiagnosed as nasal polyps in 6 cases and the misdiag- nosis rate 8.45 %. Fungal sinusitis misdiagnosed as purulent sinusitis in 5 cases and the misdiagnosis rate 2.35 %. Sinus cyst misdiagnosed as sinusitis in 8 cases and the misdiagnosis rate 3.75 %0. Conclusion：Enquiry history, care- fully specialized examination including nasal endoscopy, three-dimensional image and biopsy are crucial on the ac- curate diagnosis and reducing the misdiagnosis.