恶性胸膜间皮瘤29例分析

Treatment of Malignant Pleural Mesothelioma and 29 Cases Report

目的 探讨恶性胸膜间皮瘤诊断和治疗的临床特点。方法 回顾性分析手术治疗 2 9例恶性胸膜间皮瘤患者的临床资料。结果 术后 2年生存率为 5 1.7% (15 / 2 9) ,5年生存率为 3 1.0 % (9/ 2 9)。手术并发症发生率为 2 4.1% (7/ 2 9) ,无手术死亡者。接受根治术、姑息手术、探查术的患者 5年生存率存在明显差异 ;局限型患者 5年生存率高于弥漫型患者。患者生存率与TNM分期明显相关。结论 手术治疗恶性胸膜间皮瘤有效。国际间皮瘤研究组提出的新的恶性胸膜间皮瘤TNM分期标准客观且可行。Ⅰ、Ⅱ期患者适行手术治疗 ;Ⅳ期患者不适行手术治疗 ;对局限型、上皮型。

Objective To investigate the diagnosis and treatment of malignant pleural mesothelioma.Methods From December 1969 to February 1998,29 patients with pathologically confirmed malignant pleural mesothelioma underwent surgical treatment in our hospital.The follow-up period was at least 6 months.Results The overall survival rates were 51.7% at 2 years and 31.0% at 5 years.The operative complication rate was 24.1% without mortality from operation.5-year survival rate was significantly different between patients treated with radical resection,palliative pleurectomy,and exploratory thoracotomy.The patients with local type had a significantly better survival rate(66.7% for 2-year;53.3% for 5-year) than those with diffuse type(33.3% for 2-year, 11.1% for 5-year).The TNM staging system had a close relationship with survival rates.Conclusion Surgical intervention is appropriate treatment for selected patients with malignant pleural mesothelioma.TNM staging system provides an internationally accepted basis for the analysis of survival rates in prospective clinical trials.Pleurectomy/decortication and extrapleural pneumonectomy provide good result for patients with stage Ⅰ or Ⅱ,except those with stage Ⅳ.For patients with stage Ⅲ,radical resection is considerable for those with local type and epithelial histological type.