外科治疗10例胸膜间皮瘤临床分析

Clinical analysis of 10 patients with pleural mesothelioma in surgical treatment

目的 :探讨胸膜间皮瘤诊断、治疗和预后。方法 :收集我院胸外科自 1980年 1月～ 2 0 0 0年 6月行手术治疗的胸膜间皮瘤 10例进行回顾性分析。结果 :本组病例均无石棉密切接触史 ,临床症状主要有胸痛、胸闷、咳嗽、气促。影像学检查可见胸膜增厚、单发或多发结节 ,或伴胸腔积液 ,其中局限型 4例 ,弥漫型 6例。本组 2例行探查活检术 ,8例行手术切除 (根治性手术 5例 ,姑息性手术 3例 )。结论 :胸膜间皮瘤的发病与石棉接触史之间并无必然联系。胸水细胞学检查阳性率不高 ,胸部CT、针刺胸膜活检或胸腔镜下活检对术前确诊帮助较大。局限型间皮瘤可首选手术治疗 ,预后良好 ,弥漫型间皮瘤的预后较差 ,应考虑综合治疗 。

Purpose:To investigate the clinical features,diagnosis, surgical treament and prognosis of pleural mesothelioma. Methods:A retrospective study was conducted in a total of 10 cases of pleural mesothelioma hospitalized from January 1980 to June 2000. Results: None of the 10 patients had history of exposure to asbestos,and the clinical manifestation were chest pain and feeling of compression,cough,shortness of breath. Pleural thickening or nodules were found in radiography examaination with or without pleural effusion.Of 10 cases,4 cases were localized type and 6 cases were diffused type, 8 cases received surgery(5 cases received radical operation and 3 cases received palliative operation) Conclusions:Exposure to asbestos or not has no definite relations to pleural mesothelioma,cytology examination of pleural effusion is not very helpful in pathologic diagnosis due to low positive rate.CT scan and pleural needle biopsy are helpful preoperatively. Surgical operation is the optional treatment in localized type and the prognosis is good,but prognosis is poor in diffused type and multimodality therapy is emphasized.