目的:探讨鼻咽癌延误诊断的原因。从而提高鼻咽癌患者的早期诊断率,改善治疗效果。方法: 回顾性分析324例在我科接诊前因各种因素而延误诊断的鼻咽癌患者首发症状、首诊误诊科室、误诊疾病。结果: 本组病例首发症状分别为颈部包块138例(42.5%)、鼻部症状148例(45.6%)、耳部症状66例(20.3%)、头痛46例(14.2%)、其他17例(5.2%),有两种首发症状的病例为91例。首诊误诊的疾病有颈部淋巴结炎、慢性鼻鼻窦炎、鼻出血、分泌性中耳炎、脑动脉硬化等27种疾病。涉及普外科、耳鼻咽喉科、神经内科、骨科、呼吸内科、口腔科、烧伤科、眼科、中医科等9个科室。结论: 加强鼻咽癌知识普及,完善继续医学教育及住院医师培训,积极寻找鼻咽癌的早期诊断方法能减少鼻咽癌的延误诊断。
Objective To analyze the central visual fields and the ocular fundus changes of both eyes of patients with pituitary adenoma.Methods A total of 70 cases of pituitary adenoma received the examination of static central visual fields of all-liminal values by Humphrey instruments 750 cycloscope and the fundus exams by Topcon TRC-50X fundus photography before operations. Results There were 64.3% patients with decreased visual acuities, 80.7% with the defect of visual field, and 46 .4% with fundus changes. The decrease of the visual acuity was the first diagnostic symptom in 45.7% patients, among whom 28.6% were misdiagnosed as ocular diseases.Conclusions The misdiagnosed cause is that the first diagnostic symptom is the decrease of visual acuity without defect of visual field accompanied by ocular diseases. To avoid the misdiagnosis and the omitter of pituitary adenoma, general examination of visual field should be carried out in the patients with decreased visual acuity and optic atrophy with unknown reason in the clinical diagnosis of ophthalmology. (Chin J Ocul Fundus Dis，2003，19：18-19)