肺结核合并肺癌的诊断及影响外科治疗预后的因素分析

Cooccurrence of pulmonary tuberculosis and carcinoma: diagnosis and the prognostic factors for surgical effects

目的探讨肺结核合并肺癌的病因、诊断方法及影响外科治疗效果的因素。方法选择对肺结核合并肺癌患者外科治疗预后可产生影响的12个特征性临床因素,通过计算COX比例风险模型、累计生存率对65例施行手术治疗的患者进行了多因素分析。同时对患者的临床表现、体征、影像学检查结果进行了综合分析。结果本组患者主要临床表现为刺激性干咳、咯血,少数表现为胸背痛、发热、声嘶。胸部X线或CT检查显示:肺结核与肺癌病灶在同侧同叶53例,其中在原结核病灶处恶变47例(72.3%);同侧不同叶9例;不同侧3例。病灶形态:单纯块影19例,分叶毛刺状14例,不规则偏心空洞23例,肺不张8例,单侧胸腔积液1例。行楔形肿瘤切除4例、肿瘤所在肺叶切除38例、两肺叶切除4例、全肺切除17例、姑息性肿瘤切除2例,无围手术期死亡。本组患者64例获随访,平均随访时间5年。患者1、3、5年生存率分别为67.7%(44/65)、35.4%(23/65)、23.1%(15/65)。多因素分析表明肿瘤与原发结核病灶的关系、肿瘤手术方式及分期与患者的预后有关(P<0.01)。结论肺癌的部位与肺结核的部位密切相关,认识两者并存的临床表现、X线特征有助于肺癌的早期诊断、早期治疗。肿瘤的部位、分期、手术方式可影响患者手术预后。

Objective To study the association, clinical diagnosis and treatment of the coexistence of lung cancer and tuberculosis. Methods Sixty-five patients with coexistence of lung cancer and tuberculosis underwent surgical treatment in our hospital between 1954.1 and 2004.3. Twelve factors possibly influencing the survival were selected. A multivariate analysis of these individual variables was performed using the cumulative survival rate by the computer′ COX proportional hazard model. Results Histologically, there were 41 cases of squamous cell carcinoma, 15 adenocarcinoma, 3 small cell carcinoma and 6 mixed carcinoma. Chest radiological study showed infiltrative tuberculosis in 41, military tuberculosis in 2, and chronic fibrocavitary tuberculosis in 22 cases. Of these, wedge excision was performed in 4, lobectomy in 38, bilobectomy in 4, pneumonectomy in 17 and palliative resection in 2 patients. There was no operative mortality. Follow-up showed that 1-, 3- and 5-year survival was 67.7%(44/65), 35.4% (23/65), and 23.1%(15/65) respectively. Clinical analysis showed that the major significant prognostic factors influencing survival were malignancy occurred in local tuberculosis, the operation procedures for lung cancer, and the stage of lung cancer (P<0.01). Conclusions The occurrence of lung cancer is highly correlated to the site of tuberculosis. The recognize of this can facilitate the early diagnosis and resection of malignancy as well as the initiation of regular medical therapy.