肺隔离症误诊分析

Misdiagnosis Analysis of Pulmonary Sequestration

目的探讨肺隔离症的误诊情况、误诊原因及防范措施。方法回顾性分析万方医学数据库和中国知网数据库2005年1月至2013年12月间刊载的肺隔离症相关文献77篇,其中涉及误诊率的文献41篇。对肺隔离症的误诊率、时间、范围、后果、原因以及最终确诊手段进行分析。结果涉及误诊率的41篇文献中肺隔离症病例总数为689例,误诊例数399例,误诊率57.91%。误诊时间最短14 d,最长40年。肺隔离症最常被误诊为肺囊肿(23.16%)、支气管扩张(22.73%)、肺癌(22.08%)、肺脓肿(6.93%)及肺炎(6.28%)。绝大多数患者并未因误诊而致不良后果,但报道中4例因误诊致死,1例因误诊致手术扩大化。临床表现缺乏特异性、医生对疾病认识不足、影像学表现的多样性以及并发症或合并症掩盖了原发病是肺隔离症被误诊最常见的原因。术后病理检查(83.77%)、术中所见(13.42%)及CT血管造影(2.16%)是误诊病例最终确诊的主要手段。结论肺隔离症缺乏特异性临床表现,易误诊,影像学显示出异常的供血血管是明确诊断的关键,提高对肺隔离症的认识可减少误诊误治。

Objective To explore the status,reasons and precautions of misdiagnosis of pulmonary sequestration. Methods Seventy-seven articles about pulmonary sequestration published in Wanfang and CNKI databases between January 2005 and December 2013 were retrospectively analyzed,of which 41 articles referring to misdiagnosis rate. The misdiagnosis rate,time,status,consequence,reason and main means of definite diagnosis were analyzed. Results The total number of cases of pulmonary sequestration in the 41 articles was 689,in whom 399 cases were misdiagnosed. Misdiagnosis rate was 57. 91%. The minimum misdiagnosis time was 14 days and the maximum was 40 years. Pulmonary sequestration was most often misdiagnosed as pulmonary cyst（23. 16%）,bronchiectasis（22. 73%）,lung cancer（20. 08%）,lung abscess（6. 93%） and pneumonia（6. 28%）. Most misdiagnosed patients did not suffer adverse consequences,except4 patients were dead and 1 patient undertook unnecessary extended operation. Lack of specificity in clinical manifestations,lack of awareness of the disease,diversity of imaging performance and complications covering the original disease were the most common reasons of misdiagnosis. Postoperative pathological examination（83. 77%）,intraoperative findings（13. 42%） and computed tomography angiography（2. 16%） were the main means of definite diagnosis in misdiagnosed cases. Conclusions Pulmonary sequestration is lack of specificity in clinical manifestations and easy to be misdiagnosed. Imaging showing the abnormal blood supply vessels is the key to the diagnosis. Improving the awareness of it can reduce misdiagnosis and incorrect treatment.