肺结核合并肺癌患者手术治疗的疗效及预后分析

Efficacy and prognosis analysis of surgical treatment of patients with pulmonary tuberculosis complicated with lung cancer

目的:探讨肺结核合并肺癌的临床特征及对手术治疗疗效的影响。方法:回顾性分析2014年01月至2018年06月西安市胸科医院胸外科手术治疗的53例患者的临床资料,其中观察组17例为肺结核合并肺癌,对照组36例为肺癌,术后随访至2019年06月。统计分析两组患者的性别、年龄、症状、吸烟情况、肿瘤标志物、手术情况以及术后生存期等相关指标。结果:两组性别、年龄、症状、肿瘤标志物、结核感染T细胞检验、结核抗体、肿瘤位置、吸烟指数、体力状况评分、手术时间、术中出血量、住院日、病理类型、病理分期、术后并发症均无显著差异(P>0.05)。两组术前明确诊断率(47.1%vs 27.8%,P=0.382)差异无统计学意义;两组手术方式[(常规开胸9例,胸腔镜6例,中转开胸2例)vs(常规开胸10例,胸腔镜25例,中转开胸1例),P=0.043]、手术切除范围[(亚肺叶3例,肺叶3例,肺叶及淋巴结清扫11例)vs(亚肺叶1例,肺叶1例,肺叶及淋巴结清扫34例),P=0.021]、切口长度[15.0 cm(6.5,23.5)cm vs 6.5 cm(5.0,11.5)cm,P=0.006]、术中冰冻病理确诊率(17.6%vs 63.9%,P=0.000)差异具有统计学意义。两组术后1年、3年、4年生存率无显著差异(Log-rank testχ2=0.091,P=0.763)。结论:肺结核合并肺癌术前明确诊断率低,术中冰冻病理送检率低,术中易漏诊肺癌,根治性切除率低;肺结核合并肺癌手术治疗效果较好,预后与单纯肺癌无显著差异。

Objective:To explore clinical characteristics and efficacy of surgical treatment of pulmonary tuberculosis complicated with lung cancer.Methods:We retrospectively analyzed the clinical data of 53 surgical patients in the department of thoracic surgery,Xi'an Chest Hospital from January 2014 to June 2018.Among them,17 were lung cancer with pulmonary tuberculosis(observation group),and 36 were lung cancer(control group).Gender,age,symptom,smoking,tumor markers,operation related indicators and postoperative survival were compared between the two groups.Results:There were no significant differences in gender,age,symptoms,tumor markers,T cell test of tuberculosis infection,tuberculosis antibody,tumor location,smoking index,physical condition score,operation time,amount of hemorrhage,hospital stay,pathological type,pathological stage and postoperative complications between the two groups(P>0.05).There was no significant difference in the rate of definite preoperative diagnosis between the two groups(47.1%vs 27.8%,P=0.382).The two groups of surgical methods[(9 cases of conventional thoracotomy,6 cases of thoracoscopy,2 cases of conversion to thoracotomy)vs(10 cases of conventional thoracotomy,25 cases of thoracoscopy,1 case of conversion to thoracotomy),P=0.043],resection range[(3 cases of subpulmonary lobe,3 cases of pulmonary lobe,11 cases of pulmonary lobe and lymph node dissection)vs(1 case of subpulmonary lobe,1 case of pulmonary lobe,34 cases of pulmonary lobe and lymph node dissection),P=0.021],incision length[15.0 cm(6.5,23.5)cm vs 6.5 cm(5.0,11.5)cm,P=0.006],intraoperative frozen pathological examination rate(17.6%vs 63.9%,P=0.000)had significant difference.The 1-year,3-year and 4-year survival rates were no significant difference between the two groups(Log-rank testχ2=0.091,P=0.763).Conclusion:Pulmonary tuberculosis complicated with lung cancer has low preoperative definite diagnosis rate,low intraoperative frozen pathological examination rate,easy to miss diagnosis of lung cancer during operation,and lower radical resection rate.The surgical treatment effect of pulmonary tuberculosis complicated with lung cancer is good,and the prognosis is not significantly different from that lung cancer.