真菌性咽喉炎38例误诊分析及诊治策略

Analysis of Misdiagnosis and Strategies for Diagnosis and Treatment of 38 cases of Fungal Pharyngolaryngitis

目的提高对真菌性咽喉炎的认识,减少临床误诊误治。方法回顾分析2014年6月—2017年5月西安交通大学第二附属医院、西安市中心医院耳鼻咽喉头颈外科收治的38例真菌性咽喉炎误诊病例资料。结果本组21例咽痛,17例有咽部异物感,8例阵发性或持续性干咳,5例声音嘶哑,2例呼吸困难。查体见病变部位以咽后、侧壁、舌根常见,其次为扁桃体、披裂、会厌。局部以增生性病变、白色伪膜多见。38例误诊为普通咽炎20例,普通喉炎10例,肿瘤4例,咽喉结核2例,咽喉部梅毒、声带白斑各1例。本组经病变组织活检及细菌培养确诊为真性咽喉炎,予全身及咽喉部局限性抗真菌治疗,随访半年,37例治愈,1例一侧声带麻痹未恢复。结论加强对咽喉部真菌感染的认识,仔细全面查体,分析症状、体征、检查结果间的联系,及时有效取材活检,以避免误诊误治。

Objective To improve the understanding of fungal pharyngolaryngitis,so as reduce the misdiagnosis and mistreatment.Methods Clinical data of 38 misdiagnosed cases of fungal pharyngolaryngitis who were treated in Department of Otolaryngology Head and Neck Surgery,the Second Affiliated Hospital of Xi'an Jiaotong University and Xi'an Central Hospital from June 2014 to May 2017 were analyzed retrospectively.Results In this group,there were 21 patients with angina,17 with sensation of pharyngeal foreign body,8 with paroxysmal or persistent dry cough,5 with hoarseness and 2 with dyspnea.Physical examination showed the lesions in the posterior and lateral wall and root of the tongue,followed by tonsil,cleft,and epiglottis.Hyperplastic lesions and white pseudo membrane were found in local areas.Of the 38 cases,20 cases were misdiagnosed as common pharyngolaryngitis,10 cases as common laryngitis,4 cases as tumor,2 cases as pharynx and larynx tuberculosis,1 case as syphilis and 1 case as leukoplakia in the larynx.All patients in this group was diagnosed as true pharyngitis by biopsy of the lesions and bacterial culture,and received systemic and throat-limited antifungal treatment.At 6-month follow-up,37 cases were cured,and one case with vocal cord paralysis was not recovered.Conclusion We should be familiar with fungal pharygolaryngitis,make a careful and comprehensive examination,analyze the relationship between symptoms,signs and examination results,timely and effectively perform biopsy so as to avoid misdiagnosis and mistreatment.