24例恶性间皮瘤临床分析  

Report of 24 Patients with Malignant Mesothelioma

作　　者：张芷旋[1] 张军[2] 陈晶[1] 周澄亚[1] 龙宇[1] 马洪丽[1] 蔡晓虹[1] 

机构地区：[1]四川省肿瘤医院肿瘤内科,成都610041 [2]四川省肿瘤医院肿瘤放疗科,成都610041

出　　处：《肿瘤预防与治疗》2015年第2期71-76,共6页Journal of Cancer Control And Treatment

摘　　要：目的：探讨恶性间皮瘤的临床病理特点。方法：收集1985-2014年四川省肿瘤医院24例恶性间皮瘤患者的临床资料,回顾性分析患者的临床特点。结果：24例恶性间皮瘤患者中恶性胸膜间皮瘤18例,恶性腹膜间皮瘤6例;男17例,女7例,中位年龄52岁。恶性胸膜间皮瘤最常见症状为胸痛（7例）,活动后气促（6例）。恶性腹膜间皮瘤最常见症状为腹胀（3例）。影像学特征最常见为胸腔或腹腔积液（14例）。胸、腹腔镜或剖胸、剖腹探查术确诊17例,胸壁或皮下包块活检术确诊5例,经胸水免疫细胞化学确诊2例。病理学分型：上皮型20例,混合型2例,未分型2例。初诊时7例患者误诊（29.2%）,4例患者确诊前接受抗痨治疗（16.7%）。从发病到确诊中位时间3.3个月。21例患者接受化疗,1例行根治性手术,8例行姑息性手术,5例姑息性放疗。确诊至随访期结束中位生存时间为21个月。结论：恶性间皮瘤起病隐匿,确诊时多为局部晚期,无法行根治性手术,治疗以手术,放化疗多学科综合治疗为主,可改善症状,适当延长生存。Objective： To investigate the clinicopathological characteristics of malignant mesothelioma （MM）. Methods： Medical records of 24 malignant mesothelioma patients treated in our hospital from 1985 to 2014 were retrospectively reviewed. The clinical and pathological characteristics were analyzed. Results： Seventeen males and 7 females patients were included in this study with a median age of 52 years. Eighteen patients were diagnosed as malignant pleural mesothelioma and 6 malignant peritoneal mesothelioma. Patients with malignant pleural mesothelioma presented most commonly with chest pain （7 cases） and dyspnea after activities （6 cases）, while abdominal distension （3 cases） occurred commonly in patients with malignant peritoneal mesothelioma. The most frequent radiological features were pleural effusion or peritoneal effusion （14cases）. Seventeen cases were diagnosed via invasive procedures such as thoracoscopy, laparoscopy , open pleural biopsy or open abdomen biopsy. Five cases were diagnosed via chest wall nodule or subcutaneous nodules excisional biopsy and 2 via pleural fluid imnmnocytochemistry. Pathological diagnoses included 20 cases of epithelioid subtype , 2 biphasic sub-type and 2 non-specified sub-type. Seven cases （29.2%）were misdiagnosed at first visit and g patients （ 16.7% ） accepted anti-tuberculosis treatment before diagnosed. The median interval from start of complaints to diag- nosis was 3.3 months. Chemotherapy was administered to 21 patients, 1 patient received radical surgery, 8 patients received palliative surgery and palliative radiotherapy was given to 5 patients. The median survival from diagnosis to the end of follow up was 21 months. Conclusion： Malignant mesothelioma is an insidious tumor. A vast majority of MM patients are diagnosed in an advanced stage. The best treatment for the individual patient remains unknown. Multimodality treatment may alleviate symptoms and prolong the survival .

关 键 词：恶性胸膜间皮瘤 恶性腹膜间皮瘤 临床特点 

分 类 号：R734.3[医药卫生—肿瘤] R735.5[医药卫生—临床医学]