恶性胸膜间皮瘤15例临床分析

Clinical analysis of 15 patients with pleural mesothelioma

目的:探讨恶性胸膜间皮瘤的临床特点、诊断、治疗和预后。方法:回顾分析我院1994年10月至2005年11月收治的15例恶性胸膜间皮瘤患者的临床资料。结果:恶性胸膜间皮瘤的主要症状为胸闷、气促、咳嗽、胸痛;CT和X线主要表现为胸腔积液、胸膜不规则增厚、肺转移;胸水以渗出液为主,胸水LDH≥500u/L,葡萄糖<3.35mmol/L,血清CEA升高,血清CA125升高;主要依据手术后病检、胸膜穿刺活检、胸水细胞学检查确诊。结论:恶性胸膜间皮瘤以胸闷、胸痛、气促、咳嗽为主要表现,胸膜活检及胸水细胞学为主要确诊方法。有手术机会,多学科综合治疗者,预后较好。

Objective ：To investigate the clinical features, diagnosis, treatment of pleural mesothelioma. Methods： A retrospective study was conducted in a total of 15 cases of pleural mesothelioma hospitalized from October 1994 to November 2005. Results：Of all the 15 cases,9 cases are male,6 cases are female. Patients age were from 30 to 76. None of the 15 patients had history of exposure to asbestos. 12 patients had feeling of cimpression and shortness of breath in their clinical symptom, 11 patients had cough, 4 patients had clinically characteristic with chest pain. Through the CT and X - ray findings, we could find 5 cases showing pleural effusion and with pleural thickening among 4 of them,and 5 patients had metastatics of lung. In the 9 pleural effusion cases ,5 cases were blood - red,7 cases lymph cell classification count over 50% . The CEA of serum in 11 cases were detected,7 cases were higher than normal. The CA125 in 9 cases were detected,5 cases were higher than normal. The CA153 of 5 cases were detected, and 3 cases were higher than normal. Of all the diagnozed cases, malignant pleural mesothelioma cells was found on cytologic examination in effusion of 6 cases,5 cases were diagnozed via the needle biopsy of pleura, and 4 cases were diagnozed through the operation examination. Conclusion： Feeling of compression, shortness of breath and cough are often in malignant pleural mesothelioma cases. Needle biopsy of pleura and cytologic examination of effusion are the most important diagnosis measure. The prognosis of the patients who had opportunity of operation and comprehensive treatment is better.