胃肠道恶性肿瘤合并活动性肺结核的处理策略

目的探讨胃肠道恶性肿瘤合并活动性肺结核患者的处理策略。方法回顾性分析9例合并活动性肺结核胃肠道恶性肿瘤患者诊治资料。结果术前给予2周乙氨丁醇、异烟肼、利福平及吡嗪酰胺(EIRP)或异烟肼、利福平及吡嗪酰胺(IRP)强化联合抗结核病治疗后,所有患者均接受根治性肿瘤切除术,术后静脉给予异烟肼或二线抗结核药,患者可以口服时继用术前抗结核强化方案。术后2例并发肺炎,无结核播散恶化或死亡病例。7例术后强化治疗2个月痰菌转阴后改为异烟肼及利福平(IR)巩固治疗。在抗结核治疗巩固期同时行FOLFOX4或CapeOX方案化疗8疗程,无结核恶化病例。结论胃肠道恶性肿瘤合并活动性肺结核术前给予强化抗结核治疗2周后可行手术。术后可静脉给予抗结核药物。患者可以口服后可继用术前抗结核强化治疗。于抗结核巩固期开始肿瘤化疗安全可行。

Treatment strategies for patients with gastrointestinal carcinoma combining active tuberculosis

Objective To investigate the treatment methods for gastrointestinal carcinoma eases combining active tuberculosis. Methods The clinic data of 9 cases with gastrointestinal carcinoma combining active tuberculosis were analyzed retrospectively. Results After strengthening and combining tuberculotherapy of EIRP or IRP for 2 weeks, all patients were carried on radical resection for malignant lesions. After operation, isonicotinyl hydrazide or second echelon drug for tuberculosis was drop intravenously. When the patient could take medicine, the primary EIRP or IRP was used. There were two cases complicating pneumonia, no tuberculosis dissemination or death case. Seven cases received consolidation tuberculotherapy with IR when no acid-fast bacilli was found in expectoration after strengthening tuberculotherapy for 2 months. FOLFOX4 or CapeOX chemotherapy were safely applied in the 7 patients during consolidation tuberculotherapy stage, and no worsening tuberculosis case was met. Conclusions It is reasonable for patients with gastrointestinal carcinoma combining active tuberculosis to receive radical resection after enforcing tuberculotherapy for two weeks. Intravenous tuberculotherapy drug could be used after operation. EIRP or IRP would be administered when the patient could take medicine. Chemotherapy may be safely carried on at the time of consolidation tuberculotherapy.