恶性腹膜间皮瘤6例报道并文献复习  

Malignant peritoneal mesothelima:report of 6 cases and literature review

作　　者：刘松涛[1] 于红卫[1] 朱跃科[1] 孟庆华[1] 

机构地区：[1]首都医科大学附属北京佑安医院肝病重症医学科,100069

出　　处：《北京医学》2017年第9期906-909,共4页Beijing Medical Journal

摘　　要：目的总结恶性腹膜间皮瘤的临床特点,提高诊治水平。方法对首都医科大学附属北京佑安医院2005年3月至2016年10月收治的6例经病理证实为恶性腹膜间皮瘤患者的临床资料进行回顾性分析,并复习相关文献。结果 6例患者中,男4例,女2例;合并乙肝肝硬化2例;临床表现以腹胀、腹痛、食欲下降为主,无发热、腹泻等症状;阳性体征主要是腹部质韧和腹水征,压痛和反跳痛不明显;腹腔积液检查提示白细胞数不同程度升高,肿瘤标志物仅发现CA125升高,中位值64.66 IU/ml;腹部CT均发现腹膜、肠系膜不均匀增厚。给予抗感染药物治疗,症状未缓解,5例患者经腹膜活检后明确诊断,1例经腹水细胞学检查明确。4例术后分别给予化疗和(或)放疗等,生存时间6~27个月;保守治疗2例,生存时间分别为1个月和3个月。结论恶性腹膜间皮瘤临床表现类似自发性腹膜炎,容易误诊,但是无发热和腹部压痛等症状,实验室常规检查无明显异常指标,抗感染治疗无效,及时获取腹膜标本方可明确诊断。一般预后较差,采取综合治疗手段可延长生存时间。Objective To summarize the clinical features of patients diagnosed as malignant peritoneal mesotheli- ma, and to improve the current understanding of the disease. Methods The clinical data of 6 malignant peritoneal meso- thelima patients treated during 2005 to 2016, were retrospectively analyzed and the literatures were reviewed. Results There were 4 male and 2 female patients, and 2 patients had HBV-related cirrhosis. Abdominal distension, abdominal pain and poor appetite were the most common clinical symptoms, fever and diarrhea were absent. Positive physical examina- tion included abdominal rigidity and ascites, tenderness and rebound tenderness were not evident. Peritoneal effusion ex- amination showed the number of white blood cell increased, CA125 was the only increased tumor markers and the median was 64.66 IU/ml. The peritoneum and mesentery were unevenly thickened in abdominal CT. Symptoms were not alleviat- ed during anti-infective treatment. Pathological specimens were obtained by peritoneal biopsy in 5 patients and by ascites cytology in 1 case. The survival time of 4 cases who were treated with chemotherapy and（or）radiotherapy ranged between 6-27 months, the other 2 cases were 1 and 3 months. Conclusion The clinical manifestations are similar to spontaneous peritonitis, especially in patients with chronic liver disease might be misdiagnosed, but fever and abdominal tenderness are rare. Routine laboratory tests show no obvious abnormality. Antimicrobial treatment is ineffective. Obtain the peritoneal specimen in time is critical to diagnosis. The prognosis is usually poor, but integrated treatment could prolong the survival time.

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]