老年人肺结核并发非小细胞肺癌的外科治疗  

Surgical Treatment of Pulmonary Tuberculosis Complicated with Non-small-cell Lung Cancer in the Elderly

作　　者：阮军忠[1] 张天辉[1] 李福根[1] 段勇[1] 王子彤[1] 

机构地区：[1]首都医科大学附属北京胸科医院胸外科,101149

出　　处：《结核病与胸部肿瘤》2017年第4期290-293,共4页Tuberculosis and Thoracic Tumor

摘　　要：目的探讨老年人肺结核并发非小细胞肺癌的诊断，以及外科治疗方法和患者预后。方法搜集首都医科大学附属北京胸科医院2002年1月至2012年6月收治的老年人肺结核并发非小细胞肺癌患者40例，均经过外科手术后病理确诊。肺癌与肺结核病灶在同一肺叶者26例，不同肺叶者14例。结果本组40例老年患者，15例患者术前接受抗结核药物治疗，6例患者根据术后病理结果，给予术后抗结核药物治疗；其余19例患者考虑为陈旧性结核病灶，未给予抗结核药物治疗。所有患者接受手术治疗，其中单个肺叶切除25例，复合肺叶切除5例．全肺切除1例，楔形和段切除9例；无一例围手术期死亡。术后肺癌病理分期：Ⅰ＋Ⅱ期患者29例，1年生存率为93．1％（27／29），5年生存率为68．9％（20／29）；而Ⅲa期的11例患者中，1年生存率为90．9％（10／11），5年生存率为27．3％（3／11）。结论对于老年人肺结核并发非小细胞肺癌患者，早期诊断、合理确定治疗方案、争取早期手术治疗非常重要；术后肺癌病理分期为Ⅰ、Ⅱ期的患者5年生存率较满意。Objective To investigate the diagnosis, surgical treatment and prognosis of elderly patients with pulmonary tuberculosis complicated with non-small-cell lung cancer （NSCLC）. Methods Forty elderly cases with pulmonary tuberculosis complicated with NSCLC confirmed by pathological diagnosis were collected in Beijing Chest Hospital, Capital Medical University during January 2002 to June 2012. There were 26 cases of lung cancer and pulmonary tuberculosis in the same lung lobe, 14 cases with different lung lobes. Results Of 40 cases, 15 cases underwent anti- tuberculosis treatment before operation, 6 cases underwent anti-tuberculosis treatment after operation according to pathological result. 19 cases didn＇t give anti-tuberculosis treatment due to consider as healed tuberculosis. All patients received surgical treatment, in which a single lobe resection in 25 cases, 5 cases of compound lobectomy, pneumonectomy in 1 case, and 9 cases of wedge resection and segmentectomy. No perioperative death occurred. Postoperative pathological staging of lung cancer：Ⅰ ＋ Ⅱ in 29 patients, 1 year survival rate was 93.1% （27/29） and the 5 year survival rate was 68.9% （20/29）; and 11 cases of a patients, 1 year survival rate was 90. 9% （10/11）, the 5 year survival rate was 27.3% （3/11）. Conclusion Early diagnosis, reasonable treatment plan, early surgical treatment is very important in the elderly patients with pulmonary tuberculosis complicated with NSCLC. The postoperative pathological staging for lung cancer of stage Ⅰ and Ⅱ , 5 years survival rate of the patients are satisfactory.

关 键 词：老年人 结核 肺 癌 非小细胞肺 肺外科手术 

分 类 号：R734.2[医药卫生—肿瘤]