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相關文獻
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頁籤選單縮合
題 名 | Clinical Characteristics of Patients with Coexisting Bronchogenic Carcinoma and Pulmonary Tuberculosis=合併有肺癌和肺結核的病人之臨床研究 |
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作 者 | 林偉傑; 朱遠志; 陳炯睿; 李政宏; 陳昌文; | 書刊名 | 胸腔醫學 |
卷 期 | 17:2 2002.06[民91.06] |
頁 次 | 頁120-127 |
分類號 | 415.462 |
關鍵詞 | 肺結核; 肺癌; 鱗狀上皮細胞癌; Pulmonary tuberculosis; Bronchogenic carcinoma; Squamous cell carcinoma; |
語 文 | 英文(English) |
中文摘要 | 先前有許多研究顯示,肺結核的病人肺癌的發生率比一般人高,而且這些同時具有肺結核與肺癌的病人的預後也較差。不幸的是,要早期診斷出這些病人是困難的,因為在影像學上肺癌的表現常與肺結核類似,在症狀和病徵上,兩者也皆不具特異性。所以我們回顧性研究26位從1989至2001年間在本院診斷出同時具有肺癌和肺結核的病人。結果顯示,大多數的病人是男性且長期抽煙的老年人,組織學上以鱗狀上皮細胞癌佔50%為大多數。我們把這些病人分成兩組:一開始即被懷疑有肺癌的病人和僅肺結核被懷疑的病人。我們發現那些一開始不被懷疑有肺癌的病人,其痰液acid-fast bacilli呈陽性反應的比例比另一組高(p<0.05),而且肺癌和肺結核居於同側肺的比例也比另一組高(p<0.05)。這兩點很明顯延誤肺癌的診斷。大多數我們的病人癌症被診斷出來已經是末期了,而且僅有三位可以接受手術治療。結論是,要早期診斷出同時合併有肺癌和肺結核的病人是困難的,尤其是當痰液呈陽性acid-fast bacilli時。唯有靠臨床醫師對高危險群的肺結核病人保持高度的警覺性,才能提早診斷出合併的肺癌,並改善其預後。 |
英文摘要 | Several previous studies have demonstrated a higher incidence of lung cancer in patients with pulmonary tuberculosis than in the general population. There has also been evidence that lung cancer patients with coexisting pulmonary tuberculosis may have a poor prognosis. Unfortunately, the early diagnosis of carcinoma in patients with tuberculosis is difficult because bronchogenic carcinoma often masquerades the changes in pulmonary tuberculosis in their radiographic manifestations. Besides, the signs and symptoms of both diseases are frequently non-specific. We retrospectively reviewed the medical records of 26 patients with coexisting bronchogenic carcinoma and pulmonary tuberculosis who were diagnosed between 1989 and 2001. In order to determine whether there is a difference in the clinical and radiological features, the patients who were initially suspected of having carcinoma were compared with those who were not. Most of our patients were elderly and male chronic cigarette smokers. Squamous cell carcinoma was most common histologically, and accounted for 50% of these cases. The patients who were not initially suspected of lung cancer had a significantly higher incidence of sputum positive for acid-fast bacilli (p<0.05), and a more frequent occurrence of lung cancer and pulmonary tuberculosis appearing in the same lung (p<0.05). Both obviously contributed to a delay in the diagnosis of carcinoma. The majority had been in an advanced stage at the time of diagnosis of carcinoma, and only 3 of our patients had lesions amenable to adequate resection. We concluded that the early diagnosis of coexisting bronchogenic carcinoma and pulmonary tuberculosis is difficult, particularly if the sputum is positive for acid-fast bacilli. Only a high level of suspicion and the close surveillance of high-risk patients with pulmonary tuberculosis offer an early opportunity to diagnose and consequently improve the prognosis of this coexisting disease. |
本系統中英文摘要資訊取自各篇刊載內容。