肺结核合并肺癌的外科治疗  

Surgical treatment of pulmonary tuberculosis with lung cancer

作　　者：陈穗[1] 梁永怡[1] 江涛[1] 黄晓强[1] 

机构地区：[1]广州市胸科医院外科,510095

出　　处：《中国保健营养（下半月）》2010年第10期25-27,共3页China Health Care & Nutrition

摘　　要：目的探讨肺结核合并肺癌的相关性，诊断及外科治疗方式。方法对2000年1月至2009年10月在本院手术经病理确诊肺结核合并肺癌20例，结合文献及本组患者的临床资料进行回顾性分析。结果20例均经手术治疗，肺癌根治术17例（其中VATS辅助1例），剖胸探查术2例（其中VATS1例），楔形切除术1例。术后接受化疗者6例。术后随访1年生存率为45％，3年生存率30％。结论肺结核是肺癌的成因，钙化的淋巴结、结核性瘢痕、陈旧性空洞壁及其支气管、肺泡上皮细胞的增殖化生等与肺癌的发生有关。但初治肺结核合并肺癌，可能是老年人结核病与肺癌的发病率都高，在发生时间上相互重叠，从而两病并存的机率增多。也可能是肺癌和肺结核的发病率均增高，两者并存是一种巧合。结合文献及本组病例的特点对老年男性，长期吸烟，咳嗽，胸痛，反复痰中带血，规则抗结核治疗期间或停药观察期间肺部阴影异常增大，X线上病灶边界不清、分叶、不规则毛刺、偏心空洞等，要警惕合并肺癌的可能。条件许可的力争早期手术切除肿瘤，术前掌握病人心、肺、肝、肾功能及远处转移情况制定合适的手术方案，尽可能行根治性切除，术后辅助放疗、化疗及抗结核治疗。对于初治肺结核尤其是茵阳患者，应先争取短期（3—4周）抗结核治疗后，尽早切除肿瘤，有助于改善生存质量及延长生存时间。要提高生存率必须早期发现，早期手术治疗方可改善肺结核并发肺癌患者的生活质量，延长寿命。Objective To explore the correlation, diagnosis and surgical treatment of tuberculous with lun cancer. Methods On January 2000 to October 2009 with pathologically confirmed in our hospital surgery in 20 cases of pulmonary tuberculosis with lung cancer, and literature and the clinical data of patients were analyzed retrospectively. Results 20 patients were treated by surgery, 17 cases of lung cancer resection （VATS assisted one case in which）, exploratory thoracotomy in 2 cases （VATS assisted one case in which）, wedge resection in 1 case. 6 patients received chemotherapy after surgery. Were followed up for 1 year survival rate was 45%, 3-year survival rate of 30%. Conclusion Tuberculosis is a cause of lung cancer, calcified lymph nodes, tuberculosis scars, old and bronchial wall cavity, alveolar epithelial cell proliferation, metaplasia, etc. related to the occurrence of lung cancer. But the initial treatment of pulmonary tuberculosis with lung cancer, may be the elderly tuberculosis and lung cancer incidence rates are high, in the event of overlapping time and thus increase the probability of coexistence of two diseases. May also be the incidence rates ofhmg cancer and tuberculosis increased, the coexistence of the two is a coincidence. And literature and the characteristics of the patients were elderly men, long-term smoking, cough, chest pain, recurrent bloody sputum, rules or stopping anti-TB treatment during the observation period during the abnormal increase of pulmonary shadows, X-ray unclear lesion borders , lobulation, irregular burr, eccentric hole and so on, to be alert to the possibility of lung cancer combined. Early surgical conditions permit strive to remove the tumor, master patient preoperative heart, lung, liver and renal function, and distant metastases to develop an appropriate operation plan, as far as possible, a radical resection, postoperative radiotherapy, chemotherapy and anti-TB treatment. For the initial treatment of tuberculosis, especially smear patients, should strive for sho

关 键 词：结核 肺 肺肿瘤 诊断 肺外科手术 

分 类 号：R521[医药卫生—内科学]