恶性腹膜间皮瘤13例临床特点及诊治体会

Clinical analysis of 13 cases malignant peritoneal mesothelioma

目的:探讨恶性腹膜间皮瘤的临床特点、诊断方法和治疗方法及预后。方法:对13例经病理证实的恶性腹膜间皮瘤临床病例进行回顾性分析。结果:13例恶性腹膜间皮瘤中,主要临床表现为腹胀9例(69.2%),腹痛6例(46.2%);主要体征为腹水11例(84.6%),腹部包块3例(27.3%);血、腹水肿瘤标记物升高、渗出性腹水及影像学提示腹膜及网膜增厚是常见的客观特征,误诊率高(8例,61.5%),确诊有赖于各种有创性方法获取病理证实。手术切除或行腹腔镜下减瘤术4例(30.8%),腹腔化疗8例(61.5%),全身化疗7例(53.8%),其中4例腹腔化疗联合全身化疗。本组中位生存期仅2.8个月。结论:该病临床表现缺乏特异性,诊断应尽早并尽可能取腹膜病理活检,治疗应采用以手术、全身及或局部化疗为主的综合治疗方法。

Objective： To study the clinical characteristic, diagnosis and treatment of malignant peritoneal mesothelioma. Methods：The clinical data of 13 patients with malignant peritoneal mesothelioma pathologically confirmed were retrospectively analyzed. Results：Of 13 cases, abdominal distension （9 cases） and abdominal pain（6 cases） were the main clinical features. Ascites （ 11 cases）and abdominal mass（3 cases） were key physical sign. Increasing tumor makers in blood and ascites, exudative ascites and thickening peritoneal were common features. The rate of misdiagnosis was 61.5% in this group. The final diagnosis depends on pathological examination by various means. Surgical resection was given in 4 patients, local abdominal cavity chemotherapeutic instillations in 8 patients, systemic chemotherapy in 7 patients （local combined systemic chemotherapy in 4 patients）. The median time of survival was only 2. 8 months in this group. Conclusion ： Due to unspecific clinical symptoms, malignant peritoneal mesothelioma＇s final diagnosis depends on pathological examination as early as possible. And treatment should be combined methods including operation, local and/or systemic chemotherapy.