恶性腹膜间皮瘤的临床分析  

Clinical analysis of malignant peritoneal mesothelioma

作　　者：周淑萍[1] 金鑫鑫[1] 路又可[1] 万海军[1] 袁柏思[1] 汪芳裕[1] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)消化内科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2012年第3期249-251,共3页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81070289)

摘　　要：目的恶性腹膜间皮瘤是一种罕见的恶性肿瘤,具有起病隐匿、进展迅速、预后差的特点。文中总结恶性腹膜间皮瘤的临床诊治经验,以期提高研究人员对该病的认识。方法对17例经病理证实的恶性腹膜间皮瘤临床资料进行回顾性分析。17例恶性腹膜间皮瘤中,男6例、女11例,出现症状的年龄多超过40岁(14例,82.4%),主要临床表现为腹痛7例(41.2%)、腹胀8例(47.1%),主要体征为腹水8例(47.1%)、腹部包块7例(41.2%),出现症状至确诊时间多在3月内。结果血清糖原抗原CA125在所检测的7例患者中有5例升高;确诊前B超或CT检查发现腹水和(或)腹部包块(结节)者15例(88.2%);确诊的方式主要为开腹手术(11例,64.7%);病理类型中最主要为上皮型(15例,88.2%),肉瘤型和混合型各1例;术后行腹腔局部灌注化疗7例(41.2%),全身化疗5例(29.4%),减瘤术5例(29.4%);中位随访时间为13.5月(1月～12年),其中3例患者死亡。结论影像学及血清CA125水平在恶性腹膜间皮瘤的诊断中具有一定的提示意义,确诊须依据病理诊断;并应采用以手术为主的综合治疗方法。Objective Malignant peritoneal mesothelioma（MPM） is a rare and invariably fatal neoplasm with occult onset,rapid progression and poor prognosis.This study is to summarize our experience in the diagnosis and treatment of MPM in order to improve the recognition of the disease.Methods We retrospectively analyzed the clinical data of 17 cases of pathologically confirmed MPM.Six of the patients were males,and the other 11 were females.Symptoms presented at the age of over 40 years in 14 cases（82.4%）.The main clinical manifestations were abdominal pain（7 cases,41.2%） and abdominal distention（8 cases,47.1%）,while the main signs were ascites（8 cases,47.1%） and abdominal mass（7 cases,41.2%）.Most of the cases were confirmed within 3 months after the appearance of symptoms.Results The level of serum CA125 was found higher than normal in 5 of the 7 patients examined.Ultrasonography and/or CT revealed ascites and/or abdominal mass in 15 cases before final diagnoses,which were chiefly based on abdominal surgery（11 cases,64.7%）.Pathologically,15 cases（88.2%） were of the epithelial type and 1 case the sarcoma and mixed type.Postoperatively,abdominal chemotherapy was performed in 7 cases（41.2%）,systemic chemotherapy in 5（29.4%） and cytoreductive surgery in 5（29.4%）.The median follow-up time was 13.5 months（1 mo to 12 yr）,during which 3 of the patients died.Conclusion Radiological evidence and serum CA125 levels are valuable for the diagnosis of MPM,but the final diagnosis depends on pathological findings.A combined therapy based on surgery should be adopted for the treatment of disease.

关 键 词：恶性腹膜间皮瘤 诊断 治疗 

分 类 号：R735.5[医药卫生—肿瘤]