女性腹膜恶性间皮瘤26例诊治分析

Diagnostic and therapeutic analyses for peritoneal malignant mesothelioma： a report of 26 women

目的探讨腹膜恶性间皮瘤（PMM）的病因、临床病理特点及预后。方法回顾性分析2000年3月至2010年12月26例浙江省余姚市人民医院女性PMM患者的诊治资料，患者年龄41～78岁，21例（81％）有石棉接触史。26例PMM以腹胀、腹痛、腹水和盆腹腔肿块为主要表现，部分有恶液质，晚期均有肠梗阻。结果26例患者血清和腹水肿瘤标志物以CA125升高为主，腹水均为渗出性，部分（31％）腹水脱落细胞阳性。B超和CT检查可见腹水、腹膜增厚和腹盆腔肿块，大网膜呈“饼状”。26例病理大体分型弥漫型23例，局限型3例；组织病理结合免疫组化检查，上皮型14例，肉瘤型3例，混合型9例。行肿瘤细胞减灭术16例，仅行腹腔镜检查术10例，接受化疗23例。行肿瘤细胞减灭术与仅行腹腔镜检查的生存期比较，差异无统计学意义（P〉0．05）；化疗≤6疗程与〉6疗程的生存期比较，差异无统计学意义（P〉0．05）。结论石棉接触是PMM发病的高危因素，PMM临床表现无特异性，应结合实验室和影像学检查及时作出临床诊断，确诊有赖于组织病理和免疫绀化检查，手术和化疗不能有效延长患者生存期，预后极差。

Objective To investigate the etiology, elinicopathologic features and prognosis of peritoneal malignant mesothelioma （PMM）. Methods The diagnostic and therapeutic data for PMM from March 2000 to December 2010 were retrospectively analyzed for 26 women. They had an age range of 41 -78 years old. Among them, 21 patients （81%） had a history of exposure to asbestos. Their major symptoms were abdominal distension, abdominal pain, aseites and abdominopelvie mass. Some had cachexia. Intestinal obstruction occmTed in all cases during a late stage. Results Among them, the tumor marker of CA125 increased markedly in serum and ascitic samples. The positive rate of ascitic cytology was 31%. Type B ultrasound and CT （computed tomography） examinations showed ascites, peritoneal thickening and abdominopelvic mass and pie-shaped omentum. Their general pathological classifications were as follows： diffuse type （n=23）, localized type （n=3）, epithelial （n =14）, sarcoma （n=3） and mixed type （n = 9）. Cytoreductive surgery was performed in 16 cases. Ten patients underwent only laparoscopy while 23 patients received chemotherapy. The comparison of life span was not statistically significant between cytoreductive surgery and laparoscopy （ P 〉 0. 05 ） ; the difference of life span between ≤ 6 courses of chemotherapy and 〉 6 courses was not statistically significant （ P 〉 0.05 ）. Conclusion The history of exposure to asbestos is a risk factor for PMM. PMM with no specific clinical features should be combined with laboratory and imaging studies to make a timely clinical diagnosis. Final diagnosis should be based upon histopathological and immunohistochemical examinations. Surgery and chemotherapy do not prolong the life span of patients. And the patients have a very poor prognosis.