慢性阻塞性肺疾病合并支气管肺癌的临床研究

目的探讨慢性阻塞性肺病（COPD）合并原发性支气管肺癌的发病机制、临床特征、早期诊断及治疗方法。方法对48例COPD合并肺癌患者发病年龄、性别、临床表现及选择的治疗方法进行回顾性分析。结果48例患者中,男39例（81.3%）,女9例（18.7%）,大量吸烟史37例（77.1%）。病理类型：鳞癌26例（54.2%）,腺癌11例（22.9%）,小细胞癌5例（10.4%）,未定型癌6例（12.5%）。TNM分期：I期2例（4.2%）,Ⅱ期3例（6.2%）,ⅢA＋B期32例（66.7%）,Ⅳ期11例（22.9%）。出现可疑症状到确诊时间：1个月内1例（2.1%）,2～6个月29例（60.4%）,7～12个月12例（25.0%）,1年以上6例（12.5%）。治疗方法：手术切除2例（4.2%）,姑息性放和/或化疗13例（27.1%）,射频消融治疗5例（10.4%）,中医治疗15例（31.3%）,仅做对症、支持治疗9例（18.7%）,放弃治疗4例（8.3%）。结论COPD患者合并肺癌的症状无特异性,早期确诊率低。COPD患者伴胸痛、血痰、咳嗽性质的改变、胸腔积液、进行性消瘦应警惕合并肺癌的可能;定期X线和痰脱落细胞筛查对COPD合并肺癌的早期发现有一定的临床意义;胸部CT和纤支镜检查对COPD合并肺癌的临床诊断价值大。COPD合并肺癌的治疗以改善生活质量为主。

An analysis of 48 cases of chronic obstructive pulmonary disease mergerd lung cancer

Objective To explore possible pathogenesis,clinical feature and early period diagnosis of chronic obstructive pulmonary disease(COPD)mergered primary bronchogenic carcinoma.Methods A total of 48 patients with COPD mergered lung cancer were analysed,including possible pathogenesis,clinical feature and early period diagnosis.Results In all of 48 patients,39 were males(81.3%)and 9 were females(18.7%),37cases with smoking history(77.1%).Pathologic examination showed 26 cases of squamous cell carcinoma(54.2%),11 cases of acinic cell carcinoma(22.9%),5 cases of small cell carcinoma(10.4%),and 6 cases were not be confirmed(12.5%).According to TNM classification of pulmonary carcinoma,there were 2 cases in stage I(4.2%),3 cases in stage II(6.2%),32 cases in stage IIIA B(66.7%)and 11 cases in stage IV(22.9%).The numbers of all of 48 cases given excision,radiotherapy and/or chemotherapy,chinese medicine,radio frequencytherapy,Supportive treatment and giving up any therapy were 13(27.1%), 15(31.3%),5(10.4%),9(18.7%),4(8.3%)respectively.Conclusions There were no specific symptoms in the patients with chronic obstructive pulmonary disease(COPD)mergered primary bronchogenic carcinoma,so early period diagnosis rate was very low..Patients with COPD companied chestpain,sputumblood,the change of cough quality,soundhoarseness,hydrothorax and creasing thinness should alert the possibility of mergered lung cancer.Regular check of radiology and sputum shedding cell examination may be of value in early diagnosis,Chest CT and fribobronchscopy have more clinic value in diagnosis of COPD mergered lung cancer.