15例弥漫性恶性胸膜间皮瘤的临床病理特征及诊断分析  

Clinicopathological characteristics and diagnostic analysis of 15 cases with diffuse malignant pleural mesothelioma

作　　者：张卫东[1] 魏金星[1] 吴晓明[1] 薛明强 陈家令[1] 梁庆正[1] ZHANG Weidong;WEI Jinxing;WU Xiaoming;XUE Mingqiang;CHEN Jialing;LIANG Qingzheng(Department of Thoracic Surgery,Henan Provincial Chest Hospital, Zhengzhou 450008, Chin)

机构地区：[1]河南省胸科医院胸外科,郑州450008

出　　处：《临床肿瘤学杂志》2018年第4期363-366,共4页Chinese Clinical Oncology

摘　　要：目的分析弥漫性恶性胸膜间皮瘤的临床病理特征,探讨诊断思路,以期提高早期诊断率。方法回顾性分析2015年1月至2017年7月明确诊断的15例弥漫性恶性胸膜间皮瘤患者的临床资料及诊断方法。结果胸痛、胸闷为全组患者的主要症状。影像学检查显示,15例反复出现胸腔积液(红色胸腔积液8例),13例胸膜呈环状增厚,7例纵隔淋巴结增大。11例行胸腔积液检查的患者中10例黏蛋白定性(Rivalta)试验阳性,2例癌胚抗原(CEA)阳性,1例腺苷脱氢酶(ADA)阳性。15例患者中,血清CEA检查阳性1例,结核菌素实验(PPD试验)阳性2例。确诊前10例患者行抗结核治疗,5例行抗感染治疗,仅1例患者短期内明确诊断。15例患者发病至明确诊断时间为(266.7±210.0)天,其中6例经外科手术(包括经胸腔镜及开胸)行胸膜活检确诊,7例经CT穿刺行胸膜活检确诊,2例经彩超穿刺胸膜活检确诊。14例患者确诊前经多次胸腔积液病理、胸膜活检检查。结论弥漫性恶性胸膜间皮瘤的临床症状、实验室检查、影像学检查缺乏特异性,确诊时间较长,对于反复出现胸腔积液及胸膜增厚的患者需引起重视。单纯胸腔积液病理诊断率极低,对原因不明的胸膜疾病,需尽早行胸膜活检,外科胸腔探查是其主要手段之一。Objective To analyze the clinicopathological characteristics of diffuse malignant pleural mesothelioma and explore the diagnostic ideas in order to improve early diagnosis rate. Methods The clinical data and diagnostic methods of 15 patients with diffuse malignant pleural mesothelioma from January 2015 to July 2017 were retrospectively analyzed. Results The main symptoms were chest pain and chest tightness of 15 patients. Imaging examination showed 15 cases with pleural effusion（8 cases of red pleural effusion）,13 cases with pleural thickening and 7 cases with mediastinal lymph node enlargement. There were 10 positive of Rivalta test,2 positive of CEA,and 1 positive of ADA in 11 patients with pleural effusion examination. Among 15 patients underwent serum examination,CEA was positive in 1 patients and tuberculin experimentation was positive in 1 patient. Ten patients were treated with anti-tuberculosis treatment,5 cases received anti-infection and symptomatic support treatment,and only 1 patient was diagnosed in a short time. The average time from onset of symptoms to diagnosis was（266. 7±210. 0） days. Among them,6 cases were diagnosed by pleural biopsy through surgical operation （including thoracoscopy and thoracotomy）,7 cases were diagnosed by pleural biopsy by CT puncture,and 2 cases were diagnosed by color doppler ultrasound biopsy. Fourteen patients were examined by pleural biopsy and pleural biopsy before diagnosis. Conclusion Diffuse malignant pleural mesothelioma is characterized by lack of specificity in clinical symptoms,laboratory examination and imaging examination. It takes a long time to diagnose,and attention should be paid on recurrent pleural effusion and pleural thickening. The pathological diagnosis rate of pure pleural water examination is very low. Pleural biopsy is needed as early as possible for unexplained pleural disease,and the surgical thoracic exploration is one of the main methods.

关 键 词：胸膜间皮瘤 弥漫性 诊断 

分 类 号：R734.3[医药卫生—肿瘤]