局限型恶性腹膜间皮瘤的临床分析(附68例报告)

Clinical Analysis of the Localized Malignant Peritoneal Mesothelioma

目的总结局限型恶性腹膜间皮瘤(LMPM)的诊治经验。方法检索并筛选出2014年10月以前国内正式发表的LMPM的临床研究文献38篇,获得病例65例,合并同期我院收治的3例,共计68例,对其临床资料进行回顾性总结分析。结果68例患者中,男性30例,女性38例,男女比例为1∶1.27,平均年龄为57.6岁。主要临床表现为上腹部疼痛或腹胀不适(76.9%)和上腹肿块(58.5%)。有石棉接触史患者占41.7%。48例(92.3%)患者行CT检查,其中腹腔积液16例,肝脏转移11例。术后病理所见肿瘤类型以上皮型多见(76.7%),肿瘤平均直径为12.2 cm。治疗方式以细胞减瘤手术加腹腔热灌注化疗为主。结论LMPM是一种少见的恶性肿瘤,好发生于老年人,男女比例接近。临床表现及影像学特点不典型,联合实验室检查方法有助于提示本病,诊断依靠病理学检查,开展细胞减瘤术加腹腔热灌注化疗可有效延长患者的生存期。

Objective To summarize the diagnosis and treatment of localized malignant peritoneal mesothehoma （LMPM）. Methods A total of 68 cases of LMPM were analyzed retrospectively, including 65 patients in the literature concerning LMPM published in Chinese medical journals be- fore October 2014 plus 3 cases of LMPM admitted in The First Hospital of China Medical University in the same period. Results Among the 68 cas- es, 30 cases were male, 38 cases were female, with a male to female ratio of 1 ： 1.27. Mean age was 57.6 years. Major chnical manifestations includ- ed abdominal pain or discomfort （76.9%） and palpable abdominal masses （58.5%）. Patients （41.7%） had the history of exposure to asbestos. Among the 48 cases （ 92.3% ） that underwent CT examination, ascites was found in 16 cases, and hepatic metastasis was found in 11 cases. Most of the tumors were epithehal type （76.7%）, with a mean diameter of 12.2 cm. The main therapeutic strategy was combination therapy of cytoreductive surgery with intraperitoneal hyperthemic chemotherapy. Conclusion LMPM is a rate malignant tumor that occurs predominantly in old people. Symptoms and imaging examinations are untypical. The diagnosis is dependent on pathological examination. Combining several laboratory tests could help the diagnosis. Combination therapy of cytoreductive surgery with intraperitoneal hyperthemic chemotherapy provides an adequate and efficient treatment for LMPM.