肺结核肺癌并存的临床诊断——附40例分析

CLINICAL DIAGNOSIS OF COEXISTENCE OF LUNG CANCER AND TUBERCULOSIS——AN ANALYSIS OF 40 CASES

目的探讨肺结核与肺癌并存的临床诊断。方法回顾性分析４０例肺结核合并肺癌的临床症状和胸部Ｘ线特点及其诊断过程。结果肺结核合并肺癌以并存肺鳞癌为主（７０．０％）。主要临床表现为咳嗽、咳痰及痰血。两病并存在同侧肺的为９０．０％。结核菌阳性肺结核合并肺癌时共存于同一上叶的为７６．５％，常因肺结核治疗中病变恶化或出现块影等考虑到并存肺癌，较两者非并存于同一段叶的明显多见。痰结核菌涂片阳性率为７２．５％，痰脱落细胞阳性率为７０．０％；痰脱落细胞阴性而经纤维支气管镜检查确诊的为５８．３％。结论肺结核与肺癌发生部位密切相关。认识两者并存时的临床表现、Ｘ线胸片特征，以及重视痰液细菌学、脱落细胞学和纤维支气管镜检查，可提高诊断率。

おURPOSE To study the clinical diagnosis of coexistence of lung cancer and tuberculosis.METHODS Retrospective analysis of symptoms,features of chest X ray and diagnostic process of 40 cases with both lung cancer and tuberculosis.RESULTS Lung cancer coexisting with tuberculosis are mostly squamous type(700%).Cough,white sputum and hemoptysis production are the main clinical manifestations.The occurrence of both diseases in the same side of the lung is 900%.As coexistence of both diseases in same upper lobe with positive report of tubercule bacillus is 765%,and often cancer is considered when there is coexistence of aggregation and mass appearance during treating of the tubeculosis,these situations are more commonly seen than in different lobes or segments.According to this report,the positive rate of tubercule bacillus smear and exfoliative cytology is 725% and 700% respectively,while for fibroscopy in negative cytologic cases,the 583% patients were diagnosed definitively.CONCLUSION The occurrence of lung cancer is highly correlated to the site of tuberculosis.Recognition of the clinical manifestations,characteristics of chest films of the both diseases and attention to the examinations of sputum bacteriology,exfoliative cytology and fibroscopy,may improve the diagnosis and reduce the misdiagnosis.