肺结核合并肺癌156例临床分析

目的 分析肺结核合并肺癌患者的临床特点，以便早期识别肺结核合并肺癌患者。 方法 对我院2000年1月至2011年12月确诊的156例肺结核合并肺癌患者的临床表现、肺癌病灶与肺结核病灶的关系、确诊时间、病理类型、确诊方法进行回顾性分析。 结果 肺结核合并肺癌患者以痰中带血为其常见的临床特征，CT影像以双肺上叶结节多见，部分病灶呈团块样病变；肺结核与肺癌病灶在同侧同叶19例（12.2%，19/156），病灶肺叶不同侧72例（46.2%，72/156），病灶肺叶部分重叠65例（41.7%，65/156）；已知有肺结核病史后诊断肺癌者67例（42.9%，67/156），已知有肺癌病史后诊断肺结核者6例（3.8%，6/156），2种病同时诊断者83例（53.2%，83/156），平均确诊时间从11.4个月到12.5年不等；病理类型以非小细胞肺癌为主，均通过痰查癌细胞和纤维支气管镜刷检找癌细胞获得明确诊断。 结论 肺结核合并肺癌患者具有一定的临床特点和CT影像特征，应及早明确诊断，对2种病进行早期同时治疗，以便获得较好的疗效。

Clinical analysis on coexistence of pulmonary tuberculosis and lung cancer in 156 patients

Objective To investigate the clinical characteristics and CT features of patients with pulmonary tuberculosis complicated with lung cancer and to distinguish these patients early. Methods We analyzed retro- spectively the data, such as demography, clinical characteristics, relationship of lung cancer lesions and tuberculosis focus, confirmed time, pathological type of lung cancer, confirmed diagnosis methods, from 156 pulmonary tubercu- losis patients complicated with lung cancer admitted in our hospital from Jan. 2000 to Dee. 2011. Results Pulmo nary tuberculosis accompanied by lung cancer was more common in the aged male patients. Blood-stained sputum was mainly clinical characteristic in these patients. CT scan showed that most nodular lesions localized in upper lobe. Some lesions were presented as mass. The patients with lesions localized the same lobe of ipsilateral lung were 19 （12.2%）. The lesions of pulmonary tuberculosis and lung cancer localized in different lobe among 72 cases （46.2~/oo）. In 65 cases, some lesions of pulmonary tuberculosis and lung cancer were overlapped partially. There were 67 cases diagnosed as lung cancer after pulmonary tuberculosis confirmed and 6 eases diagnosed as pulmonary tuberculosis after lung cancer confirmed. 83 cases were diagnosed as pulmonary tuberculosis and lung cancer no more than two months. The mean time of confirmed diagnosis was from 11.4 months to 150 months. The major pathological type was non small cell lung cancer （NSCI.C）. Productive cough and fiberoptic bronchoseopic brushing were the primary way to examine the tumor cells. Conclusion The patients with pulmonary tuberculosis compli- cated with lung cancer presented some special clinical characteristics and CT features. Diagnosis earlier is contribu- ted to treat synchronously in time and to improve prognosis.