易误诊为喉咽肿物的吞咽困难患者临床资料分析

The clinical data analysis of the dysphagia patients easily misdiagnosed as laryngopharyngeal mass

目的减少临床医师对喉咽肿物误诊的发生,减轻患者精神上和经济上的负担,避免过度诊疗。方法收集2008年9月—2017年6月我院门诊以吞咽困难为主诉的颈椎骨质增生患者20例,给予神经系统、耳鼻咽喉头颈外科查体,并进行放大喉镜及颈部CT扫描等检查。结果 20例患者神经内科查体均未见明显异常,放大喉镜下可见咽后壁黏膜向前隆起,颈部CT扫描示第5~6颈椎椎体前缘向前增生隆起。20例患者经过1年以上的临床随访观察,吞咽困难症状均无明显加重。结论颈椎增生可以导致吞咽困难,易误诊为喉咽肿物,应给予全面细致的神经系统及耳鼻咽喉头颈外科检查,再结合放大喉镜和颈部CT扫描检查以明确诊断。

ObjectiveTo reduce the occurrence of misdiagnosis of laryngopharyngeal masses by clinicians, reduce the mental and economic burden of patients, and avoid excessive diagnosis and treatment.MethodsClinical data of 20 cases of dysphagia in outpatient department of Otolaryngology and Neurology were retrospectively analyzed. Patients were given neurological and otolaryngological physical examination, magnifying laryngoscope, neck and head CT(computed tomography)scan.ResultsThere were no obvious abnormalities in neurological examination in 20 cases. Under magnifying laryngoscope, the posterior pharyngeal wall mucosa was protruded forward, and the anterior edge of cervical vertebral bodywas protruded forward on CT scan. After more than one year of clinical follow-up, no significant increase in dysphagiasymptoms was observed in 20 patients.ConclusionIt is found that cervical hyperplasia can lead to dysphagia, which iseasily misdiagnosed as laryngopharyngeal mass. Comprehensive and meticulous neurological system and otolaryngology headand neck surgical examination should be performed, combined with magnifying laryngoscope and neck CT scan to make adefinite diagnosis.