恶性胸膜间皮瘤45例临床分析  

Clinical Analysis of 45 Patients with Malignant Pleural Mesothelioma

作　　者：陈洁[1] 赵微[1] 刘星辰[1] 田庆[1] 杨震[1] 陈良安[1] 

机构地区：[1]解放军总医院呼吸内科,北京100853

出　　处：《中国肺癌杂志》2012年第2期97-102,共6页Chinese Journal of Lung Cancer

摘　　要：背景与目的恶性胸膜间皮瘤是一种罕见疾病,其发病率在逐年上升,早期诊断和治疗非常困难。本文旨在探讨恶性胸膜间皮瘤的临床特点、诊断及治疗,为临床提供参考。方法回顾性分析解放军总医院1997年1月-2010年12月收治的45例恶性胸膜间皮瘤患者的临床资料。结果恶性胸膜间皮瘤患者的主要临床症状为胸痛(53.33%)、胸闷气促(48.89%)和咳嗽(37.78%);CT表现主要为胸膜增厚(71.11%)、胸腔积液(60%)和肺部阴影(40%);胸水以渗出液为主,有核细胞数明显增多,以单核细胞的增多为主,乳酸脱氢酶明显增高;大部分患者临床分期为Ⅲ期和Ⅳ期;确诊的方式主要是胸腔镜,病理类型以上皮型多见,且常易被误诊为结核性胸膜炎。早期患者以手术治疗为主,而晚期患者以化疗为主,病理类型为上皮型的疾病控制率高于肉瘤型。结论恶性胸膜间皮瘤误诊率较高,其临床症状无特异性,胸部CT可提供诊断依据,组织病理学检查结合免疫组化才能确诊,治疗方式包括化疗、手术、放疗和支持治疗,普遍疗效欠佳。Background and objective Malignant pleural mesothelioma（MPM） is a rare tumor with increasing incidence,and its early diagnoses and early treatments are difficult.The aim of the current study is to investigate the clinical features,diagnoses,and treatments of MPM,and provide reference for clinical use.Methods A total of 45 MPM patients admitted in the Chinese PLA General Hospital from January 1997 to December 2010 and their clinical records were analyzed retrospectively.Results The major clinical symptoms of the patients included：chest pain（53.33%）,chest distress（48.89%） and cough（37.78%）.The CT manifestations of MPM included：pleural thickening（71.11%）,pleural effusion（60%） and lung shadow（40%）.The pleural fluid was exudative.The number of nucleated cells in the fluid increased,most of which were mononuclear cells.Moreover,the lactic acid dehydrogenase（LDH） levels in the culture medium significantly increased.The most common clinical stage of MPM patients was either stage of III or IV.Thoracoscopy was one of the main diagnosis methods,and epithelium cell type was the main pathologic type.In addition,MPM was easily misdiagnosed as tuberculous pleurisy.Patients with an early stage of MPM were mainly cured through surgery,whereas chemotherapy was applied for the patients with advance stage.The disease control rate of the patients with epithelial type was higher than that of the patients with fibrosarcoma type.Conclusion The rate of MPM misdiagnosis is high because most of the patients have untypical clinical symptoms.However, CT scan can provide an important basis for the diagnosis of MPM.The accurate diagnoses were based on pathological examinations and immunohistochemistry.The methods of treatment include chemotherapy,surgical operation,radiotherapy and supportive treatment.However,these treatments are still insufficient and require further studies.

关 键 词：恶性间皮瘤 胸膜 诊断 治疗 

分 类 号：R734.3[医药卫生—肿瘤]