64例不典型肺结核临床分析

目的：探讨不典型肺结核的诊断要点。方法对确诊的64例不典型肺结核患者的症状、检验结果、胸部CT 特点进行分析。结果64例不典型肺结核患者症状不典型、一般实验室检查特异性不高；64例胸部 CT 表现类型有肺实变型16例、结节或肿块型20例、肺门及纵膈淋巴结肿大型7例、弥漫型6例、肺不张型10例、肺纹理增多增粗型5例，位于肺结核好发部位仅18例。结论临床医生应掌握不典型肺结核表现的多样性及胸部 CT 诊断线索，对疑似肺结核患者，根据其胸部 CT 不同表现类型除及时行结核菌素试验、反复痰找结核菌外，还应积极选择行纤维支气管镜检查、经皮肺穿刺及手术探查等方法以尽早确诊。

Atypical Pulmonary Tuberculosis:Clinical Analysis of 64 Cases

Objective To explore the clinical diagnosis of atypical pulmonary tuberculosis. Methods The clinical symptoms,test results and chest CT characteristic of 64 patients with atyp-ical pulmonary tuberculosis were analyzed.Results The clinical symptoms were atypical and the specificities of general laboratory tests were lower among the 64 patients.Chest CT features in-cluded pulmonary consolidation （16 cases）,nodule or mass （20 cases）,lymph node enlargement of hilus pulmonis and mediastinum （7 cases）,diffuse miliary nodules （6 cases）,atelectasis （10 ca-ses）,and increase in lung texture （5 cases）.Only 18 of the 64 patients had atypical pulmonary tu-berculosis that was located in predilection sites of pulmonary tuberculosis.Conclusion Clinicians should master the varieties of clinical manifestations and chest CT features of atypical pulmonary tuberculosis.For patients with suspected pulmonary tuberculosis,tuberculin test and repeated sputum smear examinations should be performed timely and fiberoptic bronchoscopy,percutane-ous lung biopsy and surgical exploration should be carried out selectively to reduce misdiagnosis.