误诊为结核性腹膜炎的恶性腹膜间皮瘤六例临床分析  

Clinical characteristics of malignant peritoneal mesothelioma misdiagnosed as tuberculous peritonitis: a report of 6 cases

作　　者：刘湘红 伍浩 黄艳芬 张桂英[1] 徐美华[1] Liu Xianghong;Wu Hao;Huang Yanfen;Zhang Guiying;Xu Meihua(Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410005, China)

机构地区：[1]中南大学湘雅医院消化内科,长沙 410005

出　　处：《中华医学杂志》2019年第24期1893-1897,共5页National Medical Journal of China

摘　　要：目的 降低腹水的误诊漏诊率,提高恶性腹膜间皮瘤诊断率.方法 回顾性分析2008年5月至2018年5月中南大学湘雅医院误诊为结核性腹膜炎的恶性腹膜间皮瘤患者的临床资料特点.结果 6例患者均为男性,发病年龄42~70(52±10)岁;均无石棉接触史;以腹痛、腹胀为主诉就诊,病程1个月余至2年余;所有患者腹水性质均为渗出液,腺苷脱氨酶(ADA)均大于正常值,且在45 U/L以下;腹水乳酸脱氢酶(LDH)值>200 U/L(83.3%);1例腹水细胞学检查考虑间皮瘤;6例患者中2例行腹腔镜下活检,4例行B超引导下活检,病理学检查均为恶性间皮瘤;免疫组织化学阳性标志物MC最敏感(100%),其次是CR(67%),CK-Pan(67%),Ki-67(67%),EMA(67%);6例患者中2例患者行手术减瘤、腹腔热灌注及术后全身化疗.结论 (1)中老年男性患者出现不明原因腹水应考虑恶性腹膜间皮瘤,尽早腹腔镜或剖腹探查以明确诊断;(2)腹水中ADA及LDH水平对于鉴别结核性腹膜炎和腹膜恶性间皮瘤有意义;(3)免疫组织化学阳性标志物MC可能成为恶性间皮瘤潜在的特异性标志物;(4)采取手术减瘤、化疗等综合治疗提高患者的生存期.Objective To reduce the misdiagnosis rate of ascites and improve the diagnosis rate of malignant peritoneal mesothelioma. Methods From May 2008 to May 2018, in Xiangya Hospital of Central South University,the clinical data of malignant peritoneal mesothelioma misdiagnosed as tuberculous peritonitis were retrospectively analyzed. Results (1) Among the 6 patients, they were male;the age of onset was 42-70 (52±9.57) years old, and there was no history of asbestos exposure.(2) All cases with abdominal pain or abdominal distension were there and the course of disease was more than 1 month to more than 2 years.(3) In all patients,the nature of ascites was exudate;ADA was higher than normal value and below 45 U/L;LDH value in ascites was higher than 200 U/L (83.3%);mesothelioma was considered in ascites cytology in 1 case.(4) Laparoscopic biopsy was performed in 2 cases and B-ultrasound guided biopsy in 4 cases;Among them, malignant peritoneal mesothelioma diagnosed by pathology.(5) In Immunohistochemical positive markers, MC was the most sensitive (100%), followed by CR (67%), CK-Pan (67%), Ki - 67 (67%) and EMA (67%).(6) Two patients received treatment with operation, abdominal hyperthermic perfusion and postoperative systemic chemotherapy. Conclusions (1) Malignant peritoneal mesothelioma should be considered in middle?aged and aged male patients with unexplained ascites and early laparoscopy or laparotomy for diagnosis.(2) ADA and LDH level in ascites are significant in differentiating tuberculous peritonitis from malignant peritoneal mesothelioma.(3) Immunohistochemical positive marker MC may be a potential specific marker for malignant mesothelioma.(4)The survival time of patients is improved by comprehensive treatment such as operation and chemotherapy.

关 键 词：腹膜肿瘤 间皮瘤 腹膜炎 结核性 误诊 

分 类 号：R735.5[医药卫生—肿瘤]