127例以骨关节症状为首发表现的肺癌临床分析

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1、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、

2、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1〜6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

3、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[ABSTRACTJObjective：Toimprovethediagnosticaccuracyoflungcancerwithboneandjointsymptomsastheinitialmanifestationandreducetherateofmisdiagnosisandmisseddiagnosisinordertogetear

4、lydiagnosisandtreatmentandreducelossandpainofpatients.Methods：Thedataof127casesoflungcancerwithboneandjointsymptomsastheinitialmanifestationwereretrospectivelyanalyzedtofindtheclinicalcharacteristicsoflungcancer,therelationshipbetweeninitialmanifestationandtumorlocati

5、onandtypes,andthecausesofmisdiagnosis.Results:Mostoftheresearchedwere50to79yearsoldwithalonghistoryofsmoking,whomostlysufferedfromadenocarcinoma,squamouscarcinomaandsmallcelllungcance匚Osteoarticularmanifestationsofprimarylungcancerweremostlyjointswellingandclubbingfin

6、ger(toe)・Bonemetastasisoflungcancermanifestedaspaininmanypartsofthebodyandpaininspine(back,waistandneck)・Clubbingfinger(toe)wascommonlyseeninsquamouscarcinoma,accountingfor72.22%.Multi-jointswellingandmulti-partpainwerecommoninadenocarcinoma.Abovelungcancerwasoftenmis

7、diagnosedasostarthritis,reactivearthritis,rheumatoidarthritis，osteomyelitis，scapulohumeralperiarthritis,clubbingfinger(toe)andhypertrophicosteoarthropathy.Bonemetastasisoflungcancerwasoftenmisdiagnosedasostarthritis,sciatica,costalchondritis,cervicalspondylosis,muscle

8、fasciafibrositischroniclumbarmusclestrain,intercostalneuritis,lumbardischerniationandspinaltuberculosis.In47.24%ofthepatient