原发性胸膜肿瘤22例临床分析

Diagnosis and surgical management of primary pleural tumor:experience with 22 patients

目的 探讨原发性胸膜肿瘤的临床特点及诊治方法。方法 回顾性分析 2 2例原发性胸膜肿瘤的临床资料。结果 本组孤立性纤维性胸膜肿瘤 9例 ,均手术切除 ,术后长期存活。弥漫性恶性胸膜间皮瘤 1 3例 ,行胸膜剥脱术加辅助化疗 6例 ,平均存活 1 6个月以上 ;剖胸探查活检术后行全身化疗 5例及未手术单纯支持治疗 2例 ,均于 6个月内死亡。结论 原发性胸膜肿瘤病变弥漫性者均为恶性 ,临床表现以胸痛、胸腔积液为主 ,手术加化疗效果优于单纯化疗 ;局限性者多为良性 ,常无症状 ;治疗首选手术切除 ,但术后易复发 ,局限性者二次切除后仍可长期存活。

Objective To study the clinical manifestations,diagnostic method,surgical management and prognosis of the primary pleural tumor.Methods Twenty two patients with primary pleural tumor were analyzed retrospectively.Results All the nine patients with solitary fibrous tumor of the pleura underwent operation,and the prognosis was excellent.For the 13 patients with diffuse malignant pleural mesotheliomas,6 patients underwent pleurectomy and chemotherapy,the mean survival time was more than 16 months.Explorative operations were done in 5 patients,they received chemotherapy after the diagnosis was confirmed,2 others received supportive care alone,but none of those patients survived over half year.Conclusions All the diffuse lesion of pleura were malignant with the main clinical manifestations of chest pain and pleural effusion,the positive cytologic result can be rarely obtained.Combined operation with chemotherapy is better than chemotherapy alone.The localized tumor of pleura is generally benign and asymptomatic.Surgical operation is the first choice for most patients,but the local recurrence is likely to happen,the prognosis of the localized tumor is excellent even after second resection.