口腔颌面部结核临床误诊分析

Analysis of Clinical Misdiagnosis of Oral and Maxillofacial Tuberculosis

目的分析口腔颌面部结核临床特点、误诊原因及防范措施。方法回顾分析2019年2月至2023年5月收治2例曾误诊的口腔颌面部结核患者的临床资料。结果1例张口受限(张口度<3 cm),左侧口腔黏膜可见破溃,边缘呈虫噬状,表面覆盖脓性分泌物,外院病理检查提示慢性炎症,予抗感染治疗1周无效,入院后经胸部X线、CT检查,并再次取病变组织活检,确诊为口腔颌面部结核。1例舌背右侧见0.8 cm×1.0 cm溃疡,边界清晰,呈弹坑状,边缘呈鼠咬状,结合患者症状表现,初步诊断为创伤性口腔溃疡,给予抗感染治疗无效,进一步经胸部X线、结核抗体、病理活检及抗酸染色检查,确诊为口腔颌面部结核。误诊时间分别为12 d和7个月。2例确诊后均行抗结核治疗,6个月后复诊显示口腔糜烂黏膜、舌黏膜溃疡均愈合,预后较好。结论口腔颌面部结核症状常不典型,误诊率较高,确诊主要依靠病理学检查,复杂病例需多种方法综合分析,并仔细询问病史,查找其他部位结核病灶,及早行病理活检,必要时可试验性抗结核治疗,以提高本病诊断率。

Objective To analyze the clinical characteristics,causes of misdiagnosis and preventive measures of oral and maxillofacial tuberculosis.Methods The clinical data of 2 patients with misdiagnosed oral and maxillofacial tuberculosis treated from February 2019 to May 2023 were retrospectively analyzed.Results One patient had restricted mouth opening(mouth opening<3 cm),and the left mucosa was observed to be ulcerated with a worm like edge and covered with purulent secretions.Pathological examination in other hospitals indicated chronic inflammation,and anti-infection-resistant treatment was ineffective for 1 week.Chest X-ray and CT examinations were conducted in our hospital after admission,followed by biop-sy of the lesion tissue,which was confirmed as oral and maxillofacial tuberculosis.Due to a 0.8 cm×1.0 cm ulcer seen on the right side of the back of the tongue with a clear boundary resembling a bullet hole and mouse-bite edges,the patient was initially diagnosed as a traumatic oral ulcer combined with the symptoms of the patient,and anti-infection treatment was inef-fective.Further examination by chest X-ray,tuberculosis antibody,pathological biopsy and acid-fast staining confirmed the di-agnosis of oral and maxillofacial tuberculosis.The misdiagnosis lasted 12 d and 7 months,respectively.Both patients received anti-tuberculosis treatment after diagnosis.After 6 months,the oral erosion mucosa and tongue mucosa ulcer were healed,and the prognosis was good.Conclusion The symptoms of oral and maxillofacial tuberculosis are often atypical,and the misdiag-nosis rate is high.The diagnosis mainly depends on pathological examination.Complex cases should be comprehensively ana-lyzed by various methods,the medical history should be carefully consulted,tuberculosis lesions in other areas should be found,and pathological biopsy should be performed as soon as possible.In addition,experimental anti-tuberculosis therapy can be performed if necessary,so as to improve the diagnosis rate of the disease.