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近年来在临床工作中,发现老年肺结核并存肺癌患者并非少见,其在临床上与单纯肺结核或肺癌有许多相似之处,为今后减少误诊、漏诊,现就1992年5月——1999年10月住院的36例肺结核并存肺癌进行临床分析。 1 临床资料 1.1 一般资料 36例中男29例,女7例,男女之比4.1:1。年龄60～78岁,平均年龄69岁。有吸烟史者27例,其中25例吸烟指数为1600支/年。 1.2 诊断依据肺结核诊断依据结合临床加下列条件之一:①痰结核菌阳性(涂片或PCR)19例。②痰菌阴性,但X性胸片提示结核经抗痨治疗有效9例。③纤维支气管镜活检、胸膜活检病理组织学符合结核诊断8例。肺癌依据:肺CT检查及纤维支气管镜活检病理组织明确诊断16例;胸膜活检病理组织诊断2例;淋巴结活检病理学诊断3例;痰脱落细胞检查诊断8例;结合临床等综合性因素诊断7例。 1.3 临床表现 咳嗽30例其中13例呈呛咳或刺激性干咳;咯血或痰中带血15例;胸背痛23例;发热14例;胸腔积液4例;声音嘶哑3例;上腔静脉压迫综合征5例;体重减轻8例。 1.4 胸部X线或CT病变部位 肺结核发生在右上肺13例,其中有纤维空洞者2例;左上肺6例;双上肺4例;右肺中叶2例;右肺下叶3例;左肺下叶4例;胸腔积液4例。肺癌发生在右肺22例;左肺14例,其中中央型28例,伴肺不张8例,周围型8例,胸腔积液4例。结核?
In recent years in clinical work, found that elderly patients with pulmonary tuberculosis is not uncommon lung cancer, which is clinically with simple tuberculosis or lung cancer have many similarities for the future to reduce misdiagnosis, missed diagnosis, is now in 1992 May - 1999 October Thirty-six patients with pulmonary tuberculosis coexisted in the hospital for clinical analysis. 1 Clinical data 1.1 General Information 36 cases of male 29 cases, 7 females, male to female ratio 4.1: 1. Age 60 to 78 years old, average age 69 years old. There are 27 cases of smoking history, of which 25 cases of smoking index of 1600 / year. 1.2 Diagnosis based on the diagnosis of tuberculosis combined with clinical conditions plus one of the following: ① sputum TB positive (smear or PCR) in 19 cases. ② sputum negative, but X-ray showed tuberculous anti-tuberculosis treatment in 9 cases. ③ fiberoptic bronchoscopy, pleural biopsy histopathology consistent with tuberculosis in 8 cases. According to lung CT examination and fiberoptic bronchoscopy biopsy pathological clear diagnosis of 16 cases; pleural biopsy pathological diagnosis of 2 cases; lymph node biopsy pathological diagnosis of 3 cases; sputum exfoliated cells diagnosis of 8 cases; combined with clinical and other comprehensive diagnostic factors 7 example. 1.3 Clinical manifestations of cough in 30 cases of which 13 cases were choking or irritating dry cough; hemoptysis or sputum with blood in 15 cases; chest and back pain in 23 cases; fever in 14 cases; pleural effusion in 4 cases; hoarseness in 3 cases; superior vena cava Compression syndrome in 5 cases; weight loss in 8 cases. 1.4 chest X-ray or CT lesions in the right pulmonary tuberculosis occurred in 13 cases, including 2 cases of fibrous cavities; left upper lung in 6 cases; double upper lung in 4 cases; right middle lung in 2 cases; right lower lobe in 3 cases; left lung 4 cases of lower lobe; pleural effusion in 4 cases. Lung cancer occurred in 22 cases of right lung; left lung in 14 cases, including 28 cases of central type, with atelectasis in 8 cases, peripheral type in 8 cases, pleural effusion in 4 cases. tuberculosis?