127例以骨关节症状为首发表现肺癌临床分析.docVIP

127例以骨关节症状为首发表现的肺癌临床分析 　　【摘 要】目的：提高以骨关节症状为首发表现的肺癌诊断准确率，降低误诊漏诊率，争取早诊断、早治疗，减轻患者痛苦和损失。方法：回顾性分析127例肺癌患者的病例资料，均以骨关节症状为首发表现。分析以骨关节症状为首发表现的肺癌临床特征，首发表现与肿瘤部位、肿瘤类型的关系，常见误诊原因。结果：以骨关节症状为首发表现的肺癌临床特征有50～79岁居多，有吸烟史比例较高，以腺癌、鳞癌、小细胞肺癌为主。原发性肺癌的骨关节表现以多关节肿痛、杵状指（趾）最多见，肺癌骨转移的骨关节表现以多部位疼痛、脊柱（背、腰、颈部）疼痛最多见。杵状指（趾）在鳞癌中分布较多，占72.22%，多关节肿痛、多部位疼痛在腺癌中分布较多。以骨关节症状为首发表现的原发性肺癌常被误诊为骨关节炎、反应性关节炎、风湿、类风湿关节炎、骨髓炎、肩周炎、杵状指、肥大性骨关节病。肺癌骨转移常被误诊为骨关节炎、坐骨神经痛、肋软骨炎、颈椎病、肌筋膜纤维织炎、慢性腰肌劳损、肋间神经炎、腰椎间盘突出症、脊柱结核。有47.24%的患者在l～6个月得到确诊，联合应用X线+ CT +活检病理诊断率高。结论：当患者具备以下特征： 50岁，长期大量吸烟史，杵状指（趾），多处长骨、大关节肿痛，多部位剧痛、放射痛、静息痛，疼痛夜间加重。要高度警惕骨关节表现是肺癌所致，重要的是全面检查，合理联用多种检查技术，及时发现原发病，减少误诊漏诊。 　　【关键词】 肺源性骨关节增生症；肺性骨病；肺癌；骨转移 　　【ABSTRACT】Objective：To improve the diagnostic accuracy of lung cancer with bone and joint symptoms as the initial manifestation and reduce the rate of misdiagnosis and missed diagnosis in order to get early diagnosis and treatment and reduce loss and pain of patients.Methods：The data of 127 cases of lung cancer with bone and joint symptoms as the initial manifestation were retrospectively analyzed to find the clinical characteristics of lung cancer，the relationship between initial manifestation and tumor location and types，and the causes of misdiagnosis.Results：Most of the researched were 50 to 79 years old with a long history of smoking，who mostly suffered from adenocarcinoma，squamous carcinoma and small cell lung cancer.Osteoarticular manifestations of primary lung cancer were mostly joint swelling and clubbing finger（toe）.Bone metastasis of lung cancer manifested as pain in many parts of the body and pain in spine（back，waist and neck）.Clubbing finger（toe）was commonly seen in squamous carcinoma，accounting for 72.22%.Multi-joint swelling and multi-part pain were common in adenocarcinoma.Above lung cancer was often misdiagnosed as ostarthritis，reactive arthritis，rheumatoid arthritis，osteomyelitis，scapulohumeral periarthritis，clubbing finger（toe）and hypertrophic osteoarthropathy.Bone metastasis of lung cancer was often misdiagnosed