肺癌指骨转移临床分析

肺癌以指骨转移为首发症状17例临床分析

韩俊庆[1]韩春燕[2]毕迎惠[2]丁晓[2] 王兴文[1]盛巍[1]李冠桢[1]

[1] 250021 济南山东省立医院肿瘤中心；[2] 250012 济南山东大学医学院。

[摘要]目的：探讨原发性肺癌以指骨转移为首发症状的临床特点及发生指骨转移的机理；方法：对1991年至2007年期间有关文献报道的以指骨转移为首发症状的原发性肺癌患者的文献资料进行综合分析；结果：本文及文献报道的以指骨转移为首发症状的17例原发性肺癌患者中，其转移病灶位于左手指骨者7例，右手指骨者9例，双手指骨者1例，指骨转移病灶的数量在两手之间的分布大致相等，除3例患者其转移病灶位于指骨近节外，其余患者的转移病灶均位于其指骨末节；有6例病人的患病手指既往曾有外伤史；结论：传统的机械-解剖学说和种子-土壤学说的观点均不能解释原发性肺癌发生指骨转移的机理，临床上如遇久治不愈的手指软组织炎症，应想到有肿瘤细胞转移至此的可能性。

关键词：肺癌；首发症状；指骨转移；

The clinical analysis of 17 cases with bronchogenic carcinoma of fingers metastases as its first symptom HAN Junqing[1], HAN Chunyan[2], BI Yinghui[2], DING Xiao[2], WANG Xingwen[1], SHENG Wei[1], LI Guanzhen[1]. Department of Oncology, Shandong Provincial Hospital, Jinan 250021；Medicine School, Shandong University, Jinan 250012，China.

[Abstract] Objective Research the clinical characteristics of primary bronchogenic carcinoma with metastases of phalanges of fingers as its first symptom and the mechanism of tumor metastasis to phalanges of fingers. Methods Literature on primary bronchogenic carcinoma with metastases of phalanges of fingers as its first symptom published between 1991 and 2005 was reviewed, and was synthetically analyzed combining with the clinical data of two such patients treated in our hospital. Results 16 patients reported in the reviewed literature and this article had primary bronchogenic carcinoma with metastases of phalanges of fingers as its first symptom. 7 patients’ metastatic lesions located in their

phalanges of left hands, 8 right hands and 1 both hands. The distribution of the quantity of the phalangeal metastases between two hands was almost equal. 3 patients’metastatic lesions were situated in proximal phalanges of fingers, and the rest in distal. 6 patients’ ill fingers had had trauma history. Conclusions Neither the traditional machine-anatomy theory nor seed-soil theory could explain the mechanism of primary bronchogenic carcinoma metastasizing to phalanges of fingers, If patients with soft tissue inflammation of fingers that cannot be healed for a long time are encountered, the possibility of tumor metastasis here should be considered.

[Key Words] bronchogenic carcinoma; first symptom; metastases of phalanges of fingers.

原发性肺癌骨转移是肺癌晚期常见的临床症状之一，文献报道其发生率约为50.0%~70.0%，肺癌骨转移多发生于海绵状骨，其中发生于中轴骨者约占75.0%，发生于头颅骨者约占10.0%，发生于手足及前臂骨者约占4.0%，临床上以单纯手指末端指骨转移为首发症状的原发性肺癌患者较为少见[1]。笔者统计自1991年至2007年期间见诸于各种文献报道的此类患者共计为21例[2~19]，但其中有3例患者的文献资料经核对后被确认属重复报道[4，18，19]，另有1例患者的资料内容与文献报道的文题不尽相符[8]，故实际见诸于文献报道的以手指骨转移为首发症状的原发性肺癌患者共计应为17例[2~17]。本文就此17例此类患者的临床资料分析结果作一报道。

资料与方法

自1991年至2007年期间见诸于各种文献报道的此类患者[2~17]共计应为17例，详见表1。按照UICC 1997年修订的肺癌TNM分期标准[20]，全部病人均为临床IV期，其中男15例，女2例，男女之比为7.5：1。年龄最小者44岁，最大者78岁，平均为58.6岁。其原发病灶位于左肺者11例，右肺者6例，左右肺之比约为2：1。其中周围型肺癌6例，中心型肺癌10例，文献资料中未给出其原发病灶X线分型的右肺癌1例。在右肺中心型肺癌的3例患者中，其原发病灶指骨转移均为右手；在右肺周围型肺癌的2例患者中，其原发病灶转移至左