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中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (3): 248-253.doi: 10.3969/j.issn.1000-6621.2019.03.002

• 论著 • 上一篇    下一篇

磨玻璃样影与实性结节型肺癌并发陈旧性肺结核的临床特点

朱建坤,金锋(),王成,张运曾,乔高锋,刘大伟,赵彬   

  1. 250013 济南,山东大学附属山东省胸科医院胸外科
  • 收稿日期:2019-01-16 出版日期:2019-03-10 发布日期:2019-03-15
  • 通信作者: 金锋 E-mail:2547875348@qq.com

Analysis of clinical characteristics between lung cancer patients complicated by obsolete pulmonary tuberculosis with ground-glass opacity and with solid nodule

Jian-kun ZHU,Feng JIN(),Cheng WANG,Yun-zeng ZHANG,Gao-feng QIAO,Da-wei LIU,Bin ZHAO   

  1. Department of Thoracic Surgery,Shandong Provincial Chest Hospital Affiliated to Shandong University,Ji’nan 250013,China
  • Received:2019-01-16 Online:2019-03-10 Published:2019-03-15
  • Contact: Feng JIN E-mail:2547875348@qq.com

摘要:

目的 对比分析表现为磨玻璃样影(ground-glass opacity,GGO)型肺癌(简称“GGO型肺癌”)并发陈旧性肺结核与实性结节(subsolid-nodule,SN)型肺癌(简称“SN型肺癌”)并发陈旧性肺结核的不同临床特点,以达到早期识别及治疗磨玻璃样影肺癌并发陈旧性肺结核的目的。方法 收集我院自2008年1月 至 2018年2月确诊并符合入组标准的 45 例肺癌并发陈旧性肺结核的患者,将GGO型肺癌并发陈旧性肺结核的患者设为研究组(简称“GGO组”,共16例),SN型肺癌并发陈旧性肺结核患者设为对照组(简称“SN组”,共29例),回顾性分析两组患者临床表现、CT扫描表现、手术方式、病理类型等。计量资料组间比较采用t检验,计数资料组间比较采用χ 2检验,均以P<0.05为差异有统计学意义。结果 (1)年龄:GGO组平均年龄(51.0±6.1)岁,SN组(59.6±8.4)岁,两组比较差异有统计学意义(t=3.58, P<0.001)。(2)结核病史:GGO组平均(19.5±2.6)年, SN组平均(23.3±3.1)年,两组比较差异有统计学意义(t=4.16, P<0.001)。(3)确诊时间:GGO组平均(382.0±27.0)d,SN组平均(9.5±5.1)d,两组比较差异有统计学意义(t=77.69, P=0.000)。(4)区域淋巴结是否转移:GGO组16例(100.0%)均未见局部淋巴结转移(N0);同侧支气管周围和(或)同侧肺门淋巴结及肺内淋巴结有转移(N1) 0例(0.0%);同侧纵隔内和(或)隆突下淋巴结转移(N2) 0例(0.0%)。SN组16例(55.2%)未见N0;N1 9例(31.0%);N2 4例(13.8%);两组比较差异有统计学意义(χ 2=9.99, P=0.003)。(5)肿瘤与结核病灶的位置关系:GGO组同叶4例(25.0%),异叶12例(75.0%);SN组同叶18例(62.1%),异叶11例(37.9%);两组比较差异有统计学意义(χ 2=4.28,P=0.038)。(6)病理类型:GGO组 鳞癌1例(6.3%),腺癌14例(87.5%),大细胞癌 1例(6.3%);SN组鳞癌12例(41.4%),腺癌15例(51.7%),腺鳞癌2例(6.9%);两组比较差异有统计学意义(χ 2=6.78,P=0.029)。(7)手术方式:GGO组行肺叶切除11例(68.8%,11/16),肺段切除1例(6.2%,1/16),肺楔形切除2例(12.5%,2/16),肺叶加楔形切除2例(12.5%,2/16);SN组全部行肺叶切除(100.0%,29/29);两组比较差异有统计学意义(χ 2=15.66,P=0.000)。结论 GGO型肺癌与SN型肺癌并发陈旧性肺结核相比较,具有临床表现无特异性,发病年龄低,确诊周期长,肿瘤分布与结核病灶无明显相关,纵隔淋巴结肿大与淋巴结转移无相关性,手术方式多样及病理类型以腺癌为主等特点,为肺癌并发肺结核的一种特殊类型。

关键词: 肺肿瘤, 结核, 肺, 共病现象, 诊断显像, 早期诊断, 综合疗法, 评价研究

Abstract:

Objective To analyze the different clinical characteristics between lung cancer patients complicated by obsolete pulmonary tuberculosis with ground-glass opacity (GGO) and with solid nodule (SN) in order to indentify earlier and treat GGO type lung cancer complicated by obsolete pulmonary tuberculosis.Methods Forty-five patients with lung cancer complicated with obsolete pulmonary tuberculosis who were diagnosed in our hospital from January 2008 to February 2018 were selected. The patients with GGO type lung cancer complicated with obsolete pulmonary tuberculosis were divided into research group (“GGO group”, 16 cases). The patients with SN type lung cancer complicated with obsolete pulmonary tuberculosis were divided into control group (SN group, 29 cases). The clinical manifestation, CT scan, operation mode and pathological type of the two groups were analyzed retrospectively. t test was used in the comparison of measurement data and χ 2 test was used in the comparison of enumeration data. The difference was statistically significant between the two groups when P less than 0.05.Results (1)Age: The average age in GGO group ((51.0±6.1) years old) was less than that ((59.6±8.4 ) years old) in SN group with significant difference statistically (t=3.58, P<0.001). (2) TB history: The average time of TB history in GGO group ((19.5±2.6) years) was shorter than that ((23.3±3.1) years) in SN group with significant difference statistically (t=4.16, P<0.001). (3) Diagnosis time: The average time of confirm diagnosis in GGO group ((382.0±27.0) days) was longer than that ((9.5±5.1) days) in SN group with significant difference statistically (t=77.69, P=0.000). (4) Regional lymph node metastasis: Local lymph node metastasis was not found in all patients (16,100.0%) in GGO group. However, in SN group, local lymph node metastasis was not found in only 16 cases (55.2%), ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary lymph nodes metastases (N1) in 9 cases (31.0%), and ipsilateral mediastinal and/or subcarinal lymph node metastasis (N2) in 4 cases (13.8%). The differences in two groups were significant statistically (χ 2=9.99, P=0.003). (5) The location relationship between tumor and tuberculosis foci: The foci located in the same lobe in 4 cases (25.0%) and in different lobe in 12 cases (75.0%) in GGO group. The foci located in the same lobe in 18 cases (62.1%) and in different lobe in 11 cases (37.9%) in SN group. The differences in two groups were significant statistically (χ 2 =4.28, P=0.038). (6) Pathological types: There were squamous cell carcinoma in 1 case (6.3%), adenocarcinoma 14 cases (87.5%) and large cell carcinoma in 1 case (6.3%) in GGO group. There were squamous cell carcinoma in 12 case (41.4%), adenocarcinoma 15 cases (51.7%) and adenosquamous carcinoma in 2 case (6.9%) in SN group. The differences in two groups were significant statistically (χ 2 =6.78, P=0.029). (7) Surgical method: There were lobectomy in 11 cases (68.8%), segmentectomy in 1 case (6.3%), wedge resection in 2 cases (12.5%) and lobectomy plus wedge resection in 2 cases (12.5%) in GGO group. There were lobectomy in all cases (29, 100.0%) in SN group. The differences in two groups were significant statistically (χ 2 = 15.66, P=0.000).Conclusion Compared with SN type lung cancer, GGO lung cancer complicated with obsolete pulmonary tuberculosis has no specific clinical manifestations, low age of onset, long diagnosis period, no significant correlation between tumor distribution and tuberculosis foci, no correlation of mediastinal lymph node enlargement and lymph node metastasis, diversity of surgical methods and adenocarcinoma as dominant pathological types. It is a special type of lung cancer complicated with pulmonary tuberculosis.

Key words: Lung neoplasms, Tuberculosis, pulmonary, Comorbidity, Diagnostic imaging, Early diagnosis, Combined modality therapy, Evaluation studies