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目的 探讨多原发性支气管肺癌的诊断与治疗,以减少误诊。方法 经手术、病理证实的673例原发性肺癌中,多原发性肺癌3例,占0.4％。结果 3例均为同时性双原发癌,组织学类型组合:鳞癌——鳞癌。2例在诊治中忽视了对侧肺内病变,造成漏诊,在术后随访中得以确诊。结论 多原发性肺癌的确诊依据是:各个肿瘤在组织学上均应具备原发性肺癌的病理特征。肺癌患者术后出现临床症状,且纤维支气管镜检阳性,只要排除支气管残端癌复发,多为第二个原发癌。肺癌规范性肺切除术是多原发性肺癌的首选术式,对于T_1N_0M_0的周围型肺癌,可选用局限性肺切除术。加强术后随访工作,对于多原发性肺癌的发现有重要意义。
Objective To explore the diagnosis and treatment of multiple primary bronchogenic lung cancers to reduce misdiagnosis. Methods Among the 673 primary lung cancers confirmed by surgery and pathology, 3 were primary lung cancers, accounting for 0.4%. Results Three cases were all simultaneous dual primary carcinomas. The histological type was composed of squamous cell carcinoma and squamous cell carcinoma. In 2 cases, contralateral lung lesions were neglected during diagnosis and treatment, resulting in missed diagnosis and confirmed by follow-up. Conclusion The definitive diagnosis basis for multiple primary lung cancers is that each tumor should be histologically characterized by primary lung cancer. Clinical symptoms of lung cancer patients after surgery, and fiberoptic bronchoscopy positive, as long as the exclusion of bronchial stump cancer recurrence, mostly for the second primary cancer. Pulmonary lung resection is the first choice for multi-primary lung cancer. For T_1N_0M_0 peripheral lung cancer, limited lung resection can be used. Strengthening postoperative follow-up work is of great significance for the detection of multiple primary lung cancers.