喉结核18例误诊分析

Misdiagnosis Analysis of 18 Patients with Laryngeal Tuberculosis

目的探讨喉结核的误诊原因及其防范措施,提高临床诊断率。方法回顾分析2008年1月—2011年12月我院收治的18例喉结核首诊误诊病例的临床资料。结果本组主要表现为声音嘶哑及咽痛等,首诊均误诊,其中误诊为慢性喉炎9例,急性会厌炎5例,声带息肉、喉癌各2例,误诊率为51.4%(18/35)。12例于电子喉镜下取病变组织活检确诊;6例于电子喉镜下多次取病变组织活检仍不能确诊,PPD试验阳性,经诊断性抗结核治疗病变缓解确立诊断。本组发病至确诊时间1周～27个月,平均1.5个月。结论喉结核误诊率较高,提高对其警惕性、加强电子喉镜下鉴别诊断能力、完善结核相关检查、必要时行诊断性治疗可减少喉结核误诊。

Objective To explore misdiagnosis causes and preventive measures of laryngeal tuberculosis, in order to improve clinical diagnosis rate. Methods Clinical data of 18 misdiagnosed patients with laryngeal tuberculosis during January 2008 and December 2011 in our hospital was retrospectively analyzed. Results Main manifestations of this group were hoarseness and sore throat, and patients were all misdiagnosed at first. Five patients were misdiagnosed as having acute epiglottitis, nine patients as having chronic laryngitis, glottic polypus and two patients as having laryngeal carcinoma respectively, and the misdiagnosis rate was 51.4% （18/35）. Twelve patients were confirmed by biopsy under electronic laryngoscope; six patients were still not confirmed by repeated pathological biopsy examinations under electronic laryngoscope, results of PPD test were positive, the six patients＇lesion improved after anti-tuberculosis treatment, and laryngeal tuberculosis was confirmed in six patients. The time from onset to diagnosis was 1 week -27 months, and average time was 1.5 months. Conclusion Laryngeal tuberculosis can be easily misdiagnosed, so clinicians can reduce misdiagnosis rate by improving the awareness, strengthening differential diagnosis of tuberculosis under electronic laryngoscope, enhancing relevant examinations and giving diagnostic treatment if necessary.