作者：龚志文1,2，谢亮2，梁鸿章2，安尼瓦尔▪买买提2，程华1,2

单位：1.中山大学附属第五医院 胸外科，广东 珠海 519000；2.中山大学附属喀什地区第一人民医院 胸外科，新疆 喀什 844000

Authors:  Gong Zhiwen1,2，Xie Liang2，Liang Hongzhang2，Aniwaer▪Maimaiti2，Cheng Hua1,2

Unit:  1.Department of Thoracic Surgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, Guangdong, China;  2.Department of Thoracic Surgery, the Affiliated Kashi Hospital, Sun Yat-sen University, Kashi 844000, Xinjiang, China

摘要：

目的 分析和探讨食管癌合并肺结核患者临床特点和治疗策略。方法 收集并回顾性分析中山大学附属喀什地区第一人民医院胸外科2020年9月到2021年8月收治诊断为食管癌并进行食管癌根治术患者的病历资料,观察指标包括患者的基本信息、结核相关实验室检查[红细胞沉降率、结核菌素纯蛋白衍生物(purified protein derivative, PPD)试验、痰涂片、菌培养、T细胞斑点检测(T cell enzyme-linked immunospot assay for tuberculosis, T-SPOT)]、中转开胸、胸膜粘连、术中出血、术后第1天胸管引流量、术后并发症(肺炎、吻合口瘘、乳糜胸)、术后病理、住院天数等临床资料,对收集的资料进行统计分析。结果 按上述条件共检索到病例74例,其中单纯性食管癌患者为55例(74.3%,A组),食管癌合并非活动性肺结核患者13例(17.6%,B组),食管癌合并活动性肺结核6例(8.1%,C组)。C组患者术前均接受了2周的强化期抗结核治疗。所有患者均进行食管癌根治手术。A组和C组之间胸腔粘连情况差异有统计学意义(P<0.05),B组和C组痰涂片阳性率差异有统计学意义(P<0.05),其余观察指标在A组和C组、B组和C组之间差异均无统计学意义(P>0.05)。另外C组中有2例患者出现肝功能不全,考虑为抗结核药物的不良反应,经护肝治疗后肝功能恢复正常。结论 食管癌合并活动性肺结核患者术前给予两周指南推荐的强化期抗结核方案是安全可行的。 

关键词：食管癌; 肺结核; 手术

Abstract：

Objective  To analyze and explore the clinical characteristics and treatment strategies of patients with esophageal cancer and pulmonary tuberculosis. Methods The clinical data of patients undergoing radical esophageal cancer surgery were retrospectively analyzed from September 2020 to August 2021 in the Department of Thoracic Surgery, the Affiliated Kashi Hospital of Sun Yat-sen University. The observation indicators include basic information and detection indicators [erythrocyte sedimentation rate, PPD（purified protein derivative, PPD）experiment, sputum smear, bacterial culture, T-spot（T cell enzyme-linked immunospot assay for tuberculosis, T-SPOT）], intraoperative pleural adhesions, intraoperative bleeding, chest drainage on the first day after surgery, postoperative complications (pneumonia, anastomotic fistula, chyle fistula), postoperative pathology, and hospitalization days. Results According to the above conditions, a total of 74 cases were retrieved, of which 55 were patients with simple esophageal cancer (74.3%, group A), 13 cases of esophageal cancer with inactive tuberculosis (17.6%, group B), and 6 cases of esophageal cancer with acfore surgery, and all patients underwent radical surgery for esophageal cancer. There was a statistically significant difference in thoracic adhesions between group A and group C (P<0.05), the positive rate of sputum smears between group B and group C was statistically significant (P<0.05). Other observation indexes which were in groups A & C and groups B & C were not statistically significant differences (P>0.05). In addition, two patients in group C had liver insufficiency, which was considered as an adverse reaction of anti-tuberculosis treat ment, which was relieved after liver protection treatment. Conclusion In patients with esophageal cancer combined with active tuberculosis, it is safe and feasible to have the anti-tuberculosis treatment recommended in the guidelines before surgery.

Key Words:  Esophageal cancer; Tuberculosis; Surgery