NHẬN XÉT MỘT SỐ ĐẶC ĐIỂM BỆNH LÝ CỦA BỆNH NHÂN CÓ TỔN THƯƠNG DẠNG U ĐƠN ĐỘC NGOẠI VI PHỔI CĂN NGUYÊN DO LAO

Abstract

Objectives: To compare some clinical characteristics, thoracic computed tomography, and lesions observed by video-assisted thoracoscopic surgery (VATS) of tuberculosis patients to primary lung cancer. Subjects and methods: Prospective study, describing patients who had peripheral solitary tumor-like lesions of the lung underwent diagnosis and treatment by VATS at the Department of Thoracic Surgery - Pham Ngoc Thach Hospital, from 11/2011 to 7/2014. Results: There were 147 patients, including 47 cases of tuberculosis and 100 patients of primary lung cancer. Patients with tuberculosis had a lower mean age (49.7±11.2 vs 60.0±10.4), and a history of pulmonary tuberculosis was more common (4.1% vs 1.4%), symptoms of hemoptysis accounted for a lower proportion (2.0% vs 13.6%). On CT images, pulmonary tuberculosis accounted for a higher proportion when the tumor size was ≤ 20mm or had clear and smooth edges; When the tumor size was > 30mm, the margin was lobulated, multi-arch, irregular with many spiculations, a high probability of lung cancer. Observing the image of macroscopic lesions in VATS showed that, the signs of pleural adherent at the tumor site indicate a high probability of tuberculosis, wrinkling of the visceral pleura over the tumor, prognosis a high probability of lung cancer, the difference is statistically significant (p < 0.05). Conclusion: Age, history of pulmonary tuberculosis, symptoms of hemoptysis; tumor characteristics: size, the margin on thoracic CT images, and macroscopic lesions during surgery (adherence of the pleura at the tumor site and wrinkling of the visceral pleura over the tumor) were valuable for diagnosing of the lesions nature.