目的探讨恶性实体瘤患者中以发热为首诊症状的病因及诊断原则。方法回顾性分析2002年7月至2010年2月以发热入院、且最终诊断为恶性实体瘤的39例患者的临床资料。结果 39例患者中肝癌10例(25.6%),肺癌9例(23.1%),结直肠癌5例(12.8%),胃癌3例(7.7%),鼻咽癌3例(7.7%),肾癌3例(7.7%),卵巢癌2例(5.1%),胰腺癌2例(5.1%),腹膜恶性间皮瘤1例(2.6%),小肠平滑肌肉瘤1例(2.6%),通过影像学发现26例(66.7%)、内镜检查19例(48.7%)和手术探查3例(7.7%),所有均经病理确诊。结论警惕发热患者中恶性实体瘤的可能性,既要重视病史采集、查体和基本辅助检查,又要重视影像学和内镜技术的应用,尽量寻找诊断线索,以减少误诊率。 Objective To investigate the etiology and diagnosis of the first diagnosis of fever in patients with malignant solid tumors. Methods The clinical data of 39 patients with fever admitted from July 2002 to February 2010 and finally diagnosed as malignant solid tumors were retrospectively analyzed. Results Nineteen patients (25.6%) had liver cancer, 9 (23.1%) had lung cancer, 5 (12.8%) had colorectal cancer, 3 had gastric cancer (7.7%), 3 had nasopharyngeal carcinoma (7.7% (7.7%), 2 cases of ovarian cancer (5.1%), 2 cases of pancreatic cancer (5.1%), 1 case of peritoneal malignant mesothelioma (2.6%) and 1 case of small intestine leiomyosarcoma Twenty-six patients (66.7%) were found, 19 (48.7%) were endoscopically diagnosed and 3 (7.7%) were surgical exploration, all of which were pathologically diagnosed. Conclusion To guard against the possibility of malignant solid tumors in patients with fever, it is necessary to pay attention to the history of the acquisition, physical examination and basic auxiliary examination, but also pay attention to the application of imaging and endoscopic techniques, as far as possible to find diagnostic clues to reduce the misdiagnosis rate.