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目的熟悉不典型性肺结核诊断标准,分析误诊的原因,旨在提高临床诊疗对策。方法57例不典型性肺结核均经摄胸部X线正、侧位片、胸部CT、痰菌、PPD皮肤试验和复查结果及临床症状和体征进行回顾性分析。57例不典型性肺结核临床证实31例,手术病例证实11例,纤支镜刷检8例,经皮肺穿活检7例。结果入院前误诊为肺炎21例(37%),慢性阻塞性肺病13例(23%),支气管扩张3例(5%),肺脓肿9例(16%),纵膈和肺门疾病5例(9%),肺癌4例(7%),其他疾病2例(4%)。结论不典型性肺结核的发病出现新发病趋势,婴幼儿和老年人长期患病者不典型性肺结核增多,且早期易误诊,应根据临床综合分析及定期复查,以提高临床诊治水平,控制不典型性肺结核。
Objective To be familiar with the diagnostic criteria of atypical pulmonary tuberculosis and to analyze the causes of misdiagnosis so as to improve the clinical diagnosis and treatment strategies. Methods Totally 57 cases of atypical pulmonary tuberculosis were retrospectively reviewed with chest X - ray, lateral radiograph, chest CT, sputum bacterium, PPD skin test and review results as well as clinical symptoms and signs. 57 cases of atypical pulmonary tuberculosis clinically confirmed in 31 cases, 11 cases of surgical confirmed cases, bronchoscopy brushing in 8 cases, percutaneous lung biopsy in 7 cases. Results Before admission, 21 patients (37%) had pneumonia, 13 (23%) had chronic obstructive pulmonary disease, 3 (5%) had bronchiectasis, 9 (16%) had lung abscess, 5 had mediastinal and hilar diseases (9%), lung cancer in 4 cases (7%) and other diseases in 2 cases (4%). Conclusions The incidence of atypical tuberculosis shows a new trend of onset. Atypical pulmonary tuberculosis is a long-term infirm in infants and elders, and early misdiagnosis should be based on clinical comprehensive analysis and regular review to improve the clinical diagnosis and treatment level and control atypical Tuberculosis.