43例菌阳肺结核与肺癌并存的临床分析

目的　提高对肺结核和肺癌并存的临床特点的认识 ,避免误诊、漏诊。方法　总结 1999年 1月～ 2 0 0 3年 6月收治的 4 3例菌阳肺结核与肺癌并存患者的临床资料。结果　两病合并以老年男性患者多见 ,男女比例为 7 6∶1,6 0岁以上例数与 6 0岁以下例数之比为 3 3∶1;临床表现无特异性 ,以咳嗽、咳痰伴胸痛、咯血或血丝痰、进行性呼吸困难等呼吸系统症状和进行性体重下降、午后发热等结核中毒症状为主 ;86 1%患者的肺结核与肺癌病灶在同侧肺 ;超半数病例 (5 5 8% )肺癌的病理类型为鳞癌 ;5 5 8%的病例结核菌素试验阴性 ,半数以上病人结核抗体阴性。结论　因此已确诊肺结核 ,但经过正规抗结核治疗后病情反复或恶化 ,胸片出现病灶增大、增多、新出现胸腔积液或原有的小量积液进行性增加 ,应高度怀疑合并肺癌 ,特别是老年男性 ,在抗结核治疗中应动态观察病灶变化 ,反复检查痰脱落细胞 ,必要时行纤维支气管镜等检查 ,尽早发现或排除合并肺癌可能 ,以免延误诊治

CLINICAL ANALYSIS OF 43 CASES OF PATIENTS WITH COEXISTING PULMONARY TUBERCULOSIS AND LUNG CANCER

Objective Lung cancer can mimic or be masked by pulmonary tuberculosis, and the aim of this study was to describe the radiologic findings and clinical significance of lung cancer coexisted with pulmonary tuberculosis in order to make early diagnosis of the disease. Materials and Methods The medical records of 43 cases of patients with coexisting active pulmonary tuberculosis and lung cancer covering a period from 1999 to 2003 were retrospectively reviewed. Results Lung cancers with coexisting pulmonary tuberculosis were commonly found in male and aged patients which was clinically characteristic with cough, thorax pain, emptysis and other kind of untypical manifestation. The location of lung cancer and tuberculosis was unilateral in 86.1% of cases. More than half (55.8%) of the cases were OT negative , and 55.8% of the tumors were squamous cell carcinoma. Conclusion The possibility of coexisting lung cancer should be suspected in diagnosed tuberculosis patients who show little improvement of symptoms, progressed pleural effusion and enlarged lesions radiologically despite regular antituberculotic therapy, and further evaluation such as cytologic examination, bronchoscopy should be taken.