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目的探讨慢性阻塞性肺病(COPD)合并原发性支气管肺癌的发病机制、临床特征、早期诊断及治疗方法。方法对48例COPD合并肺癌患者发病年龄、性别、临床表现及选择的治疗方法进行回顾性分析。结果48例患者中,男39例(81.3%),女9例(18.7%),大量吸烟史37例(77.1%)。病理类型:鳞癌26例(54.2%),腺癌11例(22.9%),小细胞癌5例(10.4%),未定型癌6例(12.5%)。TNM分期:I期2例(4.2%),Ⅱ期3例(6.2%),ⅢA+B期32例(66.7%),Ⅳ期11例(22.9%)。出现可疑症状到确诊时间:1个月内1例(2.1%),2~6个月29例(60.4%),7~12个月12例(25.0%),1年以上6例(12.5%)。治疗方法:手术切除2例(4.2%),姑息性放和/或化疗13例(27.1%),射频消融治疗5例(10.4%),中医治疗15例(31.3%),仅做对症、支持治疗9例(18.7%),放弃治疗4例(8.3%)。结论COPD患者合并肺癌的症状无特异性,早期确诊率低。COPD患者伴胸痛、血痰、咳嗽性质的改变、胸腔积液、进行性消瘦应警惕合并肺癌的可能;定期X线和痰脱落细胞筛查对COPD合并肺癌的早期发现有一定的临床意义;胸部CT和纤支镜检查对COPD合并肺癌的临床诊断价值大。COPD合并肺癌的治疗以改善生活质量为主。
Objective To investigate the pathogenesis, clinical characteristics, early diagnosis and treatment of chronic obstructive pulmonary disease (COPD) complicated with primary bronchogenic carcinoma. Methods Retrospective analysis of 48 cases of COPD with lung cancer incidence of age, gender, clinical manifestations and treatment options were retrospectively analyzed. Results Among the 48 patients, 39 (81.3%) were males and 9 (18.7%) were females, and 37 (77.1%) had a history of smoking. Pathological types included squamous cell carcinoma in 26 cases (54.2%), adenocarcinoma in 11 cases (22.9%), small cell carcinoma in 5 cases (10.4%), and untreated carcinoma in 6 cases (12.5%). TNM staging was performed in 2 cases (4.2%) in stage I, 3 cases (6.2%) in stage II, 32 cases (66.7%) in stage IIIA and 11 cases (22.9%) in stage IV. Suspected symptoms to the time of diagnosis: 1 case (2.1%) in 1 month, 29 cases (60.4%) in 2 to 6 months, 12 cases (25.0%) in 7 to 12 months, 6 cases (12.5% ). Treatment: 2 cases (4.2%) were treated by surgery, 13 cases (27.1%) with palliative radiotherapy and chemotherapy, 5 cases (10.4%) with radiofrequency ablation, and 15 cases (31.3% Treatment of 9 cases (18.7%), to give up treatment in 4 cases (8.3%). Conclusions The symptoms of lung cancer complicated by COPD are nonspecific and the early diagnosis rate is low. COPD patients with chest pain, bloody sputum, changes in the nature of cough, pleural effusion, progressive thinning should be alert to the possibility of lung cancer; regular X-ray and sputum exfoliated cell screening for COPD with lung cancer early detection of certain clinical significance; chest CT And bronchoscopy for the diagnosis of COPD with lung cancer clinical value. COPD with lung cancer treatment to improve the quality of life based.