局限性胸膜间皮瘤18例临床分析

Clinical Analysis of 18 Patients with Localized Mesothelioma of the Pleura

目的 :总结经手术病理证实的 18例局限性胸膜间皮瘤的临床经验。方法 :对手术确诊为局限性胸膜间皮瘤的 18例临床资料 ,包括石棉接触史、临床表现、影像学检查、特殊检查进分析。结果 :18例局限性间皮瘤中均无石棉接触史 ,7例体检发现 ,1例表现为杵状指 ,1例表现为自发性气胸。CT表现为密度均匀、边界光整、紧邻胸膜的弧立型类圆形块影 15例 ,1例表现为一不规则混杂密度阴影占据整侧胸腔。 1例骨ECT发现有肺性骨病 ,1例CT下穿刺找到恶性间皮细胞。术后 16例病理为局限型良性纤维型间皮瘤 ,其中有 4例局部区域上皮细胞丰富 ,有恶性变 ( 2 2 % )。 1例术后病理为低度恶性、1例为恶性 ,占 11%。 1例局限性良性胸膜间皮瘤于术后两年原位复发 ( 14 % ) ,复发后病理为恶性。结论 :胸片或CT片上见与侧胸膜、纵隔胸膜紧邻的密度均匀、边界光整、弧立型类圆形块影应考虑到局限性胸膜间皮瘤之可能。治疗首选外科手术。

Objective: To summarize the experience in th e diagnosis of localized mesothelioma of the pleura. Methods: The clinical data of 18 patients with localin zed mesothelioma of the pleura were studied, including history of exposure to asbestos, clinical manifestations, x ray of chest, as well as contrasting the results of 18 operative patients. Results: No patients had history of exposure to asbe stos. 7 cases were discovered by health examination. 1 case had clubbed finger, and 1 case had spontaneous pneumothorax. The hypertrophic lung-bone joint diseas e was detected in 1 case by ECT bone scan, and one malignant mesothelial cells were d etected in 1 case by puncture under CT. 16 cases was showed localized benign fib rous pleura tumors post-surgery pathology, in which 4 had found some malignan t cells in some areas (22%). 1 case was found low-degree malignancy, and 1 case was malignancy (11%) in post-surgery pathology. One of localized benign pleura l tumor had relapsed in the same site ofter two years of sugery (14%), and it truned to malignancy. Conclusion: Surgical intervention was the optimal.