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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。
Objective To analyze the main points of clinical diagnosis of atypical pulmonary tuberculosis. Methods Retrospective analysis of 128 cases of atypical pulmonary tuberculosis clinical data and diagnostic methods. Results All patients with lung lobes, segments may be involved, involving more than two leaves in 90 cases. Sixty patients were located in the basal segment of the lower lobes of the predilection for tuberculosis, 14 patients were located in the hilar and mediastinum, 44 were in the middle and the lingual leaves, and the patients in the posterior and posterior segments of the upper lobes 36 cases, located in the anterior lobe in patients with 42 cases. Of the 128 patients, nodules or masses were found in 40 cases, diffuse in 12 cases, pulmonary consolidation in 32 cases, atelectasis in 20 cases, hilar and mediastinal lymph nodes in 14 cases, and pulmonary enlargement in 10 cases. Conclusion In the clinical diagnosis and treatment, atypical pulmonary tuberculosis due to the location, clinical manifestations, CT images are typical of the cloth, the need for a comprehensive and detailed analysis of the patient’s chest CT and other clinical data, early repeated sputum smear test, positive selection of lung Puncture and bronchoscopy. If the above method is still not diagnosed, the implementation of diagnostic anti-TB treatment or surgical exploration methods.