局限型腹膜间皮瘤22例临床分析

Clinical analysis of localized peritoneal mesothelioma

目的 探讨局限型恶性腹膜间皮瘤的临床特点及其发病与石棉接触的关系.方法 收集2007年1月1日至2012年12月31日我院诊治的经病理学确诊的局限型恶性腹膜间皮瘤22例患者的临床资料,对其发病情况、石棉接触史、临床表现、影像学检查、病理类型、免疫组织化学及肿瘤标记物检查结果等进行分析.结果 22例中多见于女性,占68.18％.出现症状至就诊时间为2d～1年,平均83 d.临床症状中局部腹痛者11例（50.00％）、腹部包块者8例（36.36％）、腹胀者6例（27.27％）、腹水者10例（45.45％）.患者多具有血小板数量增多、癌抗原（CA） 125升高.腹部CT检查表现为局部肿块,多呈囊实性,12例可见石棉斑（54.55％）.腹部超声及腹部CT检查是主要的检查方法,超声引导下腹膜穿刺病理活检是确诊的主要手段,其次为剖腹探查.病理类型主要多为上皮型共19例（86.36％）,其次为肉瘤型和混合型.18例患者（81.82％）有石棉接触史.结论 局限型恶性腹膜间皮瘤在我国少见,但在本地区较为多见,可能与石棉接触有关;临床特征以腹痛和局部肿块表现为主;病理类型以上皮型为主;手术是其主要的治疗方式.

Objective To explore the clinical characteristics of localized peritoneal mesothelioma by the retrospective analysis of the clinical data and its relationship with asbestos exposure. Methods A total of 22 cases with localized peritoneal mesothelioma confirmed by pathological test and they were selected as our subjeets in the Central Hospital of Cangzhou from Jan. 2007 to Dee. 2012. The information of all cases was collected. The incidence, asbestos exposure history, clinical manifestations, imaging studies, pathologieal type, immunohisto- chemistry and tumor markers of peritoneal mesotheliom patients were recorded or measured. Results Of 22 eases ,female accounted for 68. 18%. The periods from onset symptoms to treatment time was from 2 days to 1 year with an average of 83 days. Clinical symptoms were verified including localized abdominal pain （ 11 cases, 50. 00% ）, abdominal mass （ 8 cases, 36. 36% ）, abdominal distension （ 6 cases, 27. 27% ）, aseites （ 10 cases, 45.45% ）. Patient was with increased platelet and eareinoma antigen 125. Abdominal computerized tomography showed that local mass was seen and 12 cases were with asbestos spot. Ultrasound-guided peritoneal biopsy was confirmed as the main diagnostic method followed by Laparotomy. Epithelial type was the main pathological type （ 19 cases, 86. 36% ）, following the fleshy tumor type and mixed type. Eighteen cases had asbestos exposure history. Conclusion Localized peritoneal mesothelioma is a rare disease. However,the incidenee is high in the current region due to asbestos exposure. Abdominal pain and local mass are the main clinical symptoms, and the main pathology is epithelial typeas well as surgery is the main therapy.