中央型肺癌合并支气管结核漏诊临床报告并文献复习

Missed Diagnosis of Central Bronchogenic Carcinoma Combined with Bronchial Tuberculosis:a Case Report and Literature Review

目的探讨中央型肺癌合并支气管结核的临床特点及漏诊原因、防范措施。方法对曾漏诊中央型肺癌的中央型肺癌合并支气管结核1例的临床资料进行回顾性分析。结果患者因咳嗽、咳痰、胸闷及气短10年,痰中带血5年,加重1年入院。曾院外诊断肺结核,予抗结核治疗6个月,症状无明显改善,遂就诊河北省胸科医院。入院后经数次痰病理、肿瘤标志物、痰抗酸染色、结核感染T细胞检测、结核菌素纯蛋白衍生物试验、胸部CT及支气管镜等检查,诊断支气管结核,给予抗结核治疗2个月患者症状好转,复查胸部CT示病变吸收不明显。再次行支气管镜检查示左上叶固有支可见坏死组织较前减少,坏死物下可见新生物;咬检组织病理检查示退变异性细胞伴大量坏死组织;刷检组织病理检查发现瘤细胞。诊断中央型肺癌合并支气管结核。转肿瘤科进一步治疗。给予放化疗辅助抗结核治疗后,患者病情好转,现生存状况良好,定期行放化疗。结论临床医师加强对病情及影像学检查结果分析细心程度,提高业务技能,不过度依赖医技检查结果,并拓宽诊断思路,可减少或避免中央型肺癌合并支气管结核漏诊。

Objective To discuss clinical characteristics,causes and preventive measures of central bronchogeniccarcinoma combined with bronchial tuberculosis. Methods Clinical data of 1 missed diagnosis patient with central bronchogenic carcinoma combined with bronchial tuberculosis was retrospectively analyzed. Results The patient was admitted cough,expectoration,dyspnea and shortness of breath for 10 years,bloody sputum for 5 years and aggravation for 1 year. The patientwas diagnosed as having pulmonary tuberculosis in other hospital,and received anti tuberculosis treatment for 6 months,butthe symptoms were not significantly improved,and then the patient visited Hebei Provincial Chest Hospital. After admission,the patient received examinations such as several times of sputum pathology,tumor marker,sputum acid fast staining,tuberculosis infectious T cells detection,purified protein derivative of tuberculin （ PPD）test,chest CT and bronchoscopy,andbronchial tuberculosis was diagnosed. The patient was treated with anti tuberculosis treatment for 2 months,and the symptomswere significantly improved,but the rechecked chest CT showed no obvious lesion absorption. Rechecked tracheoscopy showedthat decreased visible necrotic tissues in the left upper lobe and neoplasm under the sphacelus. Biopsy histopathology examination showed degenerated foreign cells associated by a large number of necrotic tissues,and brushing pathological examinationshowed tumor cells. The patient was diagnosed as having central bronchogenic carcinoma combined with bronchial tuberculosis,and was transferred to oncology department for further treatment. The patient showed significant improvement in symptomsafter having chemoradiotherapy and adjunctive anti - tuberculosis therapy,and the patient had a good condition and receivedchemotherapy regularly. Conclusion Clinicians should be more careful when are analyzing the patient ＇ s condition and imaging findings,improve professional skills,not to rely on medical examination results too much and broaden their diagnosedmind so as to reduce or avoid missed diagnosis of central bronchogenic carcinoma combined with bronchial tuberculosis.