论文部分内容阅读
目的:探索鼻咽癌误诊误治发生情况及其对远处转移的影响。方法:有目的表格式调查初诊鼻咽癌患者85例的诊疗史;回顾性分析获得随访的433例不同预后患者中被颈部包块切除病检等误诊误治发生情况。结果:①85例初诊患者的误诊率达72.64%,随着医院等级升级误诊有明显下降;绝大多数患者(77.36%)均在首发症状发生后1个月内初诊;误诊病种达20种,最常见为颈淋巴结炎或结核、分泌性中耳炎;②回顾性资料433例患者中,曾被颈部包块切除病检60例,其中75%切除病检前未作过鼻咽部活检;切除病检后病理证实为转移癌后再行鼻咽部活检43例(71.67%),其余未行(20.0%)或仅行1~4次活检阴性即行放疗;鼻咽部活检证实为鼻咽癌患者43例中,仅经1次取材即阳性占79.17%;③放疗后5年以上无瘤生存患者其被误诊误治率及颈部包块切除病检率明显少于治疗前或后发生远处转移患者(P<0.05),而且其切除病检后大多数均能在1个月内获得放疗,其所占比率明显高于治疗前后远处转移者(P<0.05)。结论:误诊误治包括颈部手术切除病检即便在高等级医院也不少见;误诊误治责任主要在医生;误诊误治高发生率,尤其颈部包块切除病检,特别是切除病检后未能及时放疗,是发生远处转移因素之一。
Objective: To explore the misdiagnosis and misdiagnosis of nasopharyngeal carcinoma and its influence on distant metastasis. METHODS: The purpose of this study was to investigate the history of diagnosis and treatment of 85 newly diagnosed nasopharyngeal carcinoma patients. Retrospective analysis of 433 patients with different prognosis was followed up by misdiagnosis and misdiagnosis of cervical mass excision. Results: ① The misdiagnosis rate of 85 newly diagnosed patients was 72.64%, with the misdiagnosis of hospital grade escalation was significantly decreased; the vast majority of patients (77.36%) were newly diagnosed within 1 month after the first symptom occurred; The most common is cervical lymphadenitis or tuberculosis, secretory otitis media; ② retrospective data of 433 patients, has been removed by the mass of the neck mass examination of 60 cases, of which 75% before the removal of the nasopharyngeal biopsy; 43 cases (71.67%) of nasopharyngeal biopsies were confirmed after pathological examination of pathological changes, and the rest were not (20.0%) or only 1 to 4 biopsies were negative. The nasopharyngeal biopsy was confirmed as nasopharyngeal carcinoma Among the 43 patients, 79.17% were positive only after one time of harvesting. ③The misdiagnosis rate of misdiagnosis and neck excision disease in patients who survived more than 5 years after radiotherapy were significantly less than those before or after radiotherapy (P <0.05), and most of them were able to receive radiotherapy within one month after the resection of the disease, the proportion of which was significantly higher than that before and after treatment (P <0.05). Conclusions: Misdiagnosis and mistreatment including neck surgical resection is not uncommon even in high-grade hospitals; misdiagnosis and mistreatment mainly occur in doctors; misdiagnosis and mistreatment rate are high, especially in cervical mass resection After the failure to timely radiotherapy, is one of the factors that occur distant metastasis.