肺癌误漏诊原因分析

摘要

Objective To investigate causes and prevention methods of missed diagnosis and misdiagnosis for lung cancer. Methods Clinical data of 15 missed diagnosis or misdiagnosis patients with lung cancer admitted during January 2015 and May 2016 was retrospectively analyzed. Results All the 15 patients were primarily diagnosed in our hospital, of whom 1 patient was misdiagnosed as having cor pulmonale combined with syndrome of inappropriate antidiuretic hormone ( ADH) , 5 patients were misdiagnosed as having tuberculosis, 3 patients as having chronic cholecystitis, 4 patients as having bronchitis, and 4 patients were diagnosed as having chronic obstructive pulmonary disease ( COPD) in acute episode, and lung cancer was missed diagnosis in 2 patients. The average time of missed diagnosis and misdiagnosis was 7 d-3 months. Lung cancer was confirmed by pathologic examination of fiexible bronchofiberscope in 5 patients and by cytological examination of pleural effusion in 5 patients;other 3 patients were diagnosed as having lung cancer by thoracic CT examination, and were confirmed by pathological results after elective surgery;lung cancer was confirmed by pathologic examination of lung biopsy. Pathological results were 5 patients with squamous cell carcinoma, 5 patients with adenocarcinoma and 5 patients with small cell lung cancer. After confirming diagnosis, 12 patients underwent surgery, and 2 patients received chemotherapy, and 1 pa-tient received expectant treatment;14 patients were discharged after conditions improved by appropriate treatment, 1 patient died after treatment failure. Conclusion Clinicians should improve knowledge of clinical features and X-ray imaging findings of lung cancer. Clinician should pay more attention for patients with similar symptoms, carefully ask medical history, compre-hensively give examinations and analyze condition changes so as to eliminate or confirm lung cancer as soon as possible, and then missed diagnosis and misdiagnosis rate can be decreased.%目的 探讨肺癌误漏诊原因及防范措施.方法 对2015年1月—2016年5月宝鸡市人民医院收治的曾误漏诊的肺癌15例的临床资料进行回顾性分析.结果 15例均于我院首诊,就诊初期误诊为肺源性心脏病并抗利尿激素(ADH)分泌过多性低渗血症1例,肺结核5例,慢性胆囊炎3例,支气管炎4例,诊断慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性发作漏诊肺癌2例;误漏诊时间7 d~3个月.经纤维支气管镜活组织病理检查及胸腔积液细胞学检查确诊肺癌各5例;经胸部CT检查诊断为肺癌,择期手术后病理检查确诊肺癌3例;行经皮肺活组织病理检查确诊肺癌2例.病理诊断鳞癌、腺癌及小细胞癌各5例.本组确诊后行手术治疗12例,予化学治疗2例,保守治疗1例;14例予相应治疗后病情好转出院,1例术后治疗无效死亡.结论 临床医生应加强对肺癌临床及影像学表现的认识,提高对肺癌警惕性,遇及类似本文患者时应仔细询问病史、全方位体格检查、合理利用医技检查,并综合分析病情变化,以及早排除或确诊肺癌,降低肺癌误漏诊率.