目的 分析肺结核并发肺癌的CT表现特征及病理类型.方法 选取2011年3月1日至2016年12月31日于首都医科大学附属北京胸科医院就诊的临床及CT扫描资料齐全的肺结核并发肺癌患者71例作为研究对象.肺结核通过痰涂片或痰培养、CT扫描、实验室检查及临床治疗动态观察综合确诊;肺癌通过痰检癌细胞、支气管镜或CT引导下经皮肺穿刺活检、胸腔镜及手术标本进行病理检查确诊.观察分析研究对象的CT表现特征及病理类型分布情况.结果 71例研究对象中,非活动性肺结核45例,活动性肺结核26例;并发腺癌32例、鳞癌31例、小细胞肺癌8例.活动性肺结核并发肺癌患者中鳞癌构成比(50.0%,13/26)高于腺癌(38.5%,10/26)和小细胞肺癌(11.5%,3/26);非活动性肺结核并发肺癌患者中腺癌构成比(48.9%,22/45)高于鳞癌(40.0%,18/45)和小细胞肺癌(11.1%,5/45),但两组患者不同病理分型肺癌的分布差异无统计学意义(χ2=0.20,P=0.904).研究对象肺癌与肺结核病灶出现部位位于同侧者占74.6%(53/71),不同侧者占25.4%(18/71),差异有统计学意义(χ2=34.51,P<0.01);位于同侧同叶者占56.3%(40/71),同侧不同叶者占18.3%(13/71),不同侧者占25.4%(18/71),病灶位于同叶者的构成比明显高于位于同侧不同叶者及位于不同侧者(χ2=27.51、16.69,P值均<0.01).研究对象肺癌CT表现按部位分型包括中心型24例(33.8%),其中,按病理分型分为小细胞癌8例(33.3%,8/24)、腺癌1例(4.2%,1/24)、鳞癌15例(62.5%,15/24);周围型肺癌47例(66.2%),其中,按病理分型分为腺癌31例(66.0%,31/47)、鳞癌16例(34.0%,16/47);不同病理分型在中央型肺癌和周围型肺癌中的分布差异有统计学意义(χ2=32.07,P<0.01).周围型肺癌患者中37例患者(78.7%,37/47)病灶位于胸膜下.3例患者为肺结核动态观察中发现并发肺癌,其中,2例腺癌,1例鳞癌.结论 肺结核并发不同病理类型肺癌患者有一定的CT表现特征,肺结核与肺癌病灶位于同侧、同叶者居多;CT诊断为中心型肺癌者,鳞癌和小细胞肺癌居多;CT诊断为周围型肺癌者,腺癌居多.“,”Objective To investigate CT imaging features and clinicopathological analysis of patients with pulmonary tuberculosis coexisting with primary lung cancer.Methods Seventy-one patients with lung cancer coexisting with pulmonary tuberculosis were collected in Beijing Chest Hospital Affiliated to Capital Medical University from March 1, 2011 to December 31, 2016.Pulmonary tuberculosis was comprehensively diagnosed by sputum smear or sputum culture, CT scanning, laboratory examination, and clinical treatment of dynamic observation.Lung cancer was confirmed through the sputum cancer cells, bronchoscopy or CT guided percutaneous needle biopsy, thoracoscopy, and surgical pathology.CT imaging features and pathological types were observed and analyzed.Results Of the 71 cases, there were 45 cases of non-active pulmonary tuberculosis and 26 cases of active pulmonary tuberculosis.In the coexisten lung cancer, there were 32 cases of adenocarcinoma, 31 cases of squamous cell carcinoma, and 8 cases of small-cell lung cancer.The proportion of squamous cell carcinoma (50%, 13/26) in patients with active pulmonary tuberculosis was higher than that of adenocarcinoma (38.5%, 10/26) and small-cell lung cancer (11.5%, 3/26).The proportion of adenocarcinoma (48.9%, 22/45) in patients with non-active pulmonary tuberculosis was higher than that in squamous cell carcinoma (40.0%, 18/45) and small-cell lung cancer (11.1%, 5/45).However, there was no significant difference between the two groups of patients with different pathological types of lung cancer (χ2=0.20, P=0.904).The cases of lung cancer and pulmonary tuberculosis in the same side accounted for 74.6% (53/71), significantly higher than that in different sides (25.4% (18/71), χ2=34.51, P<0.01).Of the total 71 patients, 56.3% (40/71) lesions located in the same lobe, significantly higher than that in different lobes of ipsilateral lung (18.3% (13/71), χ2=27.51, P<0.01), and that in different pulmonary sides (25.4% (18/71), χ2=16.69, P<0.01).According to the location of lung cancer, 24 (33.8%) patients were diagnosed with central lung cancer (including 8 (33.3%) small-cell carcinomas, 1 (4.2%) adenocarcinoma, and 15 (62.5%) squamous cell carcinomas according to pathological type) and 47 (66.2%) patients with peripheral lung cancer (including 31 (66.0%) adenocarcinomas and 16 (34.0%) squamous cell carcinomas).The distribution of pathological types between central lung cancer and peripheral lung cancer was significantly different (χ2=32.07, P<0.01).Of the 47 patients with peripheral lung cancer, 37 (78.7%) lesions located under the pleura.Three cases of lung cancer were found in the dynamic observation of pulmonary tuberculosis, of which, 2 cases were adenocarcinomas and 1 case was squamous cell carcinoma.Conclusion Different pathological types of lung cancer coexisting with pulmonary tuberculosis have specific CT imaging characteristics.Most lesions of pulmonary tuberculosis and lung cancer locate in the same pulmonary side and same lobe.Squamous cell carcinoma and small-cell lung cancer account for the majority of central lung cancer, while adenocarcinoma accounts for the majority of peripheral lung cancer.