肺结核并肺癌37例临床分析

Clinical Analysis of 37 Cases of Pulmonary Tuberculosis Concomitant with Lung Cancer

目的分析肺结核合并肺癌的临床特征、影像学特点,提高诊断率。方法 回顾性分析我院诊治的37例肺结核合并肺癌的的临床资料。结果 37例中先诊断结核27例;肺癌与肺结核同时诊断8例,先诊断肺癌2例。肺癌与肺结核位于同一肺叶26例,其中17例影像学上重叠;同侧不同肺叶8例;不同侧3例。肺结核及肺癌经细胞学及病理学检查确诊,其中鳞癌18例,腺癌12例,腺鳞癌及小细胞癌各2例,未定型3例。37例均采用正规抗结核治疗,同时针对肺癌分期采取手术或放化疗治疗。其中接受手术11例,5年生存6例,1年生存2例;接受以化疗为主的综合治疗19例,中位生存期44周;4例放弃治疗,中位生存期31周;2例小细胞肺癌定期化疗,平均生存期18个月;1例伽玛刀治疗,生存至今。结论肺结核合并肺癌时,肺癌症状易被结核症状掩盖,临床医师应提高警惕。

Objective To analyze clinical and imaging characteristics of pulmonary tuberculosis concomitant with lung cancer,and to improve the diagnostic rate of the disease. MethodsThe clinical data of 37 cases of pulmonary tuberculosis concomitant with lung cancer were retrospectively analyzed. Results27 cases were diagnosed as pulmonary tuberculosis at first and then diagnosed as lung cancer,8 cases were diagnosed as pulmonary tuberculosis concomitant with lung cancer at one time,and 2 cases were diagnosed as lung cancer at first and then diagnosed as pulmonary tuberculosis.Lung cancer and tuberculosis were in the same pulmonary lobe in 26 cases,among whom,17 cases were image overlap;lung cancer and tuberculosis were in the same side but different pulmonary lobe in 8 cases;lung cancer and tuberculosis were in different sides in 3 cases.All patients were diagnosed by pathology,among whom,18 cases were squamous cell carcinoma,12 cases were adenocarcinoma,2 cases were adenosquamous carcinoma,2 cases were small cell carcinoma,and 3 cases failed to finalize the design.37 cases received anti-tuberculosis treatment,and underwent surgery or chemotherapy according to the staging of lung cancer.11 cases received surgery,6 cases survived for 5 years,and 2 cases survived for one year;19 cases received combined modality therapy with mainly chemotherapy,the media survival of them was 44 weeks;4 cases gave up the treatment,and the media survival of them was 31 weeks.2 cases of SCLC medially survived for 18 months,1 case of early lung cancer received gamma knife therapy,and has survived until now. ConclusionClinicians should be fully aware that symptoms of lung cancer are susceptible to being masked by pulmonary tuberculosis when pulmonary tuberculosis is concomitant with lung cancer.It can prolong serial time if the two diseases are treated at the same time.