腹膜假粘液瘤15例诊治体会

Diagnosis and Treatment Experience of Peritonei Pseudomyxoma in 15Cases

目的:提高对腹膜假粘液瘤的认识,探讨腹膜假粘液瘤的诊断及治疗。方法:对医院1970至2011年收治的15例腹膜假粘液瘤病例的临床资料进行回顾性分析。结果:15例患者中2例以急腹症起病,10例以腹胀起病。其中4例合并慢性腹痛,8例可扪及腹部包块,6例合并慢性消耗性表现,13例腹水征(+)。B超、CT检查均有阳性发现,表现为腹水、腹部包块,肿瘤标志物多有升高。5例术前行腹腔穿刺细胞学检查,1例确诊。15例患者中14例患者首诊均误诊,误诊率高达93.33%。手术为减瘤术,辅助治疗包括腹腔化疗和全身化疗。结论:腹膜假黏液瘤为临床少见病例,并且缺乏特异性的临床表现和检查手段,容易误诊。加强临床医师对PMP的认识,重视B超引导下腹腔穿刺细胞学检查可提高诊断符合率,确诊依赖于病理学检查。手术及术后腹腔内化疗为主要治疗措施。

Objective : To investigate the diagnosis and treatment of peritonei pseudomyxoma(PMP).Methods : Retrospective study was analyzed in 15cases of PMP treated in the hospital from 1970to 2011.Results : Main clinical presentations included 2cases with acute abdominal pain;10cases with distention including 4chronic abdominal pain;8cases with palpable mass;6cases of debilitation;13 cases with sign of ascites(+).In all cases,type-B ultrasonography and CT showed abdominal ascites and mass.In most cases,the tumor marker(CEA and / or CA 125) level was elevated.5cases were examined by abdominal paracentesis before operation.One of them had a definite diagnosis in cytological examination.In the first diagnosis,the rate of misdiagnosis was 93.33%(14 / 15).All patients underwent cytoreductive surgery.Adjunctive therapy included abdominal chemo and wholebody chemo.Conclusion : PMP is a rare disease in clinic and difficult to diagnose before surgery.PMP clinical manifestation shows no specific features.The misdiagnosis rate is very high.Abdominal paracentesis with type-B ultrasonography analysis can promote clinical diagnosis,while final diagnosis still depends on pathology.Operation and postoperative intraperitoneal chemotherapy are the main curative measures.