不典型肺结核临床诊断要点分析.doc

不典型肺结核临床诊断要点分析 　　【摘要】 目的 分析不典型肺结核的临床诊断要点。方法 回顾性分析128例不典型肺结核患者的临床资料及诊断方法。结果 所有患者肺叶、段均可受累， 累及两叶以上者有90例。位于肺结核好发部位下叶基底段的患者为60例， 位于肺门及纵隔的患者为14例， 位于中叶及舌叶的患者为44例， 位于上叶尖后段及下叶背段的患者为36例， 位于上叶前段的患者为42例。128例患者中结节或肿块型40例， 弥漫型12例， 肺实变型32例， 肺不张型20例， 肺门及纵隔淋巴结肿大型14例， 肺纹理增多增粗型10例。结论 在临床诊疗中， 由于不典型肺结核的发生部位、临床表现、CT影像均布具有典型性， 需全面、细致地分析患者的胸部CT等临床资料， 早期反复性痰涂片试验， 积极选择肺穿刺检查与纤支镜检查。若上述方法还无法进行确诊， 可实施诊断性抗结核治疗或手术探查方法 【关键词】 不典型肺结核；诊断要点；分析 DOI：10.14163/j.cnki.11-5547/r.2016.33.040 Analysis of essentials of diagnosis for atypical pulmonary tuberculosis CHE Jing-wei. Department of Outpatient， Liaoning Jinzhou City Center for Disease Control and Prevention， Jinzhou 121000， China 【Abstract】 Objective To analyze essentials of clinical diagnosis for atypical pulmonary tuberculosis. Methods A total of 128 patients with atypical pulmonary tuberculosis were taken into retrospective analysis on their clinical data and diagnosis measures. Results All patients showed involved pulmonary lobe and pulmonary segments， and there were 90 patients with both involved pulmonary lobe and pulmonary segments. There were 60 cases with basal segment of lower lobe as predilection site of pulmonary tuberculosis， 14 cases with hilus pulmonis and mediastinum， 44 cases with middle lobe and lingular lobe， 36 cases with posterior segment of superior lobe and back segment of lower lobe， and 42 cases with anterior segment of superior lobe. Among 128 patients， there were 40 cases with node or lump type， 12 cases with diffuse type， 32 cases with pulmonary consolidation type， 20 cases with pulmonary atelectasis type， 14 cases with hilus pulmonis and mediastinal lymphadenectasis type， and 10 cases with increasing and thickening lung marking. Conclusion In clinical diagnosis and treatment of atypical pulmonary tuberculosis， due to its typical occurrence site， clinical manifestation and CT imaging， it is necessary to apply comprehensive and detailed analysis of clinical data of chest CT， early repeated sputum smear test， and ac