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目的:分析巨大纵隔支气管囊肿的临床特征表现和分析误诊的原因。方法:采用回顾性方式将我院对1例巨大纵隔支气管囊肿患者的实验室检查过程、诊断过程及治疗进行分析。结果:患儿入院查体显示体温36.5℃,脉搏75次/min,呼吸20次/min,BP118/64mm Hg,血常规、血糖血脂及肝肾功能等均正常,心电图检查提示窦性心动过缓。患者主诉曾有外伤史,经腹B超提示胆囊息肉,再次复查B超有囊性暗区且形态不规整,经CT平扫后又有左后下纵隔囊性密度影,初步诊断为左后下纵隔良性占位,囊性畸胎瘤和淋巴管囊肿。实施胸腔镜手术治疗,治疗过程中发现左胸后外侧7肋间有巨大肿瘤,大小15 cm×12 cm×6 cm,经游离、双重结扎瘤蒂后切断,将瘤体取出,送去病理学活检最终诊断为支气管囊肿。分析本例出现误诊的原因主要有医院B超定位定性不准确、病灶的生长部位难于判断、囊内密度不均匀、囊肿壁厚薄及受到囊性畸胎瘤和淋巴管囊肿疾病的影响。结论:巨大纵隔支气管囊肿患者临床表现及检查结果很容易与相似疾病混在一块容易造成误诊,这就需要临床医学工作人员加深对自身医学知识的学习,在观察和诊断过程中应更更加认真,努力发现其中的问题,同时要拓宽自己的诊断思路,为临床诊断提供坚实的基础。
Objective: To analyze the clinical manifestations and analyze the causes of misdiagnosis of huge mediastinal bronchial cysts. Methods: A retrospective manner in our hospital on a case of patients with huge mediastinal bronchial cysts in the laboratory examination process, diagnosis and treatment were analyzed. Results: Children admitted to hospital showed body temperature 36.5 ℃, pulse 75 beats / min, respiration 20 beats / min, BP 118/64 mm Hg, blood routine, blood glucose and liver and kidney function were normal, ECG showed sinus bradycardia . Patients complained of history of trauma, abdominal gallbladder polyps prompted by B, once again review the B-cystic dark areas and irregular shape, after CT scan and posterior left lower mediastinal cystic densitometry, the initial diagnosis of left Lower mediastinal space, cystic teratoma and lymphatic cyst. The implementation of thoracoscopic surgery, the treatment found in the left thoracic lateral 7 intercostal giant tumors, the size of 15 cm × 12 cm × 6 cm, after free, double ligation tumor pedicle cut off, remove the tumor, sent to the pathology Biopsy eventually diagnosed as bronchial cyst. Analysis of the reasons for misdiagnosis in this case are mainly due to inaccurate qualitative diagnosis of B-ultrasound in the hospital, difficult to determine the growth site of the lesion, uneven density of the cyst, thin wall of the cyst, and diseases of cystic teratoma and lymphatic cyst. Conclusion: The clinical manifestations and examination results of patients with huge mediastinal bronchogenic cysts can easily be misdiagnosed with similar diseases, which requires clinicians to deepen their learning of medical knowledge and should be more careful and effective in observation and diagnosis Discover the problems, at the same time to broaden their diagnostic ideas, provide a solid foundation for clinical diagnosis.