恶性胸膜间皮瘤31例临床病例分析
摘要
目的
探讨恶性胸膜间皮瘤的病因、临床表现、误诊情况、诊断和治疗的临床规律以及相关进展。
方法
回顾性总结山东大学齐鲁医院1996年至2006年收治且资料完整的恶性胸膜间皮瘤患者31例，对其性别、年龄、石棉接触史、临床表现、误诊情况、影像学检查、诊断方法、治疗过程等方面进行分析。
结果
(1)本组病例男15例，女16例(男：女=1：1)，发病年龄：28-82岁，中位发病年龄：54岁，所有患者均无石棉接触史。(2)临床表现主要为胸痛、胸闷、咳嗽、气急及胸腔积液，14例X线片可见胸水，26例CT发现胸膜不规则增厚或胸腔内结节影，18例经胸膜活检和胸水细胞学检查获取病理学依据。(3)大部分患者单纯行手术治疗、放疗或化疗，3例行综合治疗。
结论
对临床上进行性胸痛、咳嗽、气急患者，胸片及CT显示有胸水并胸膜增厚或胸膜结节者应警惕胸膜间皮瘤，胸膜活检和胸水细胞学检查是主要确诊方法。对于恶性胸膜间皮瘤，综合治疗的效果较单一治疗手段好。
Objective
To investigate the clinical rule and advance in the pathogeny、diagnoses and treatment of malignant pleural mesothelioma.
MethodsA retrospective study was conducted in 31 cases of malignant pleural mesothelioma hospitalized from 1996 to 2006 ,whose clinical data was analysed including sex,age,clinical manifestations ,imaging examinations ,diagnoses and treatment.
Results
(1) Of all the 31 cases, 15 cases were male, 16 cases were female, Male: female= 1:1; the age of patients were from 28 to 82, and the expective of live were 54. All the cases had no evident history of exposure to asbestos. (2)The clinical manifestation were mainly chest pain , chest depressed , cough ,dyspnea and pleural effusion. 14 cases had pleural effusion under X-ray and pleural anomaly thickening or nodules were found in 26 cases on CT examination. Of all the diagnosed cases, 18 cases were diagnosed via biopsy of pleura and cytologic examination in pieural effusion.(3)Most cases were only treated with operation , radio- therapy and chemotherapy while 3 cases were treated with combined therapy.
Conclusion
The patient with progressive chest pain ,cough and dyspnea,who also has pleural effusion ,pleural thickening or nodules on X-ray or CT examination should pay attention to the fact that maybe he has had pleural mesothelioma. Biopsy of pleura and cytologic examination in pieural effusion are the most important diagnoses measure.To malignant pleural mesothelioma,combined therapy is better than single means.
探讨恶性胸膜间皮瘤的病因、临床表现、误诊情况、诊断和治疗的临床规律以及相关进展。
方法
回顾性总结山东大学齐鲁医院1996年至2006年收治且资料完整的恶性胸膜间皮瘤患者31例，对其性别、年龄、石棉接触史、临床表现、误诊情况、影像学检查、诊断方法、治疗过程等方面进行分析。
结果
(1)本组病例男15例，女16例(男：女=1：1)，发病年龄：28-82岁，中位发病年龄：54岁，所有患者均无石棉接触史。(2)临床表现主要为胸痛、胸闷、咳嗽、气急及胸腔积液，14例X线片可见胸水，26例CT发现胸膜不规则增厚或胸腔内结节影，18例经胸膜活检和胸水细胞学检查获取病理学依据。(3)大部分患者单纯行手术治疗、放疗或化疗，3例行综合治疗。
结论
对临床上进行性胸痛、咳嗽、气急患者，胸片及CT显示有胸水并胸膜增厚或胸膜结节者应警惕胸膜间皮瘤，胸膜活检和胸水细胞学检查是主要确诊方法。对于恶性胸膜间皮瘤，综合治疗的效果较单一治疗手段好。
Objective
To investigate the clinical rule and advance in the pathogeny、diagnoses and treatment of malignant pleural mesothelioma.
MethodsA retrospective study was conducted in 31 cases of malignant pleural mesothelioma hospitalized from 1996 to 2006 ,whose clinical data was analysed including sex,age,clinical manifestations ,imaging examinations ,diagnoses and treatment.
Results
(1) Of all the 31 cases, 15 cases were male, 16 cases were female, Male: female= 1:1; the age of patients were from 28 to 82, and the expective of live were 54. All the cases had no evident history of exposure to asbestos. (2)The clinical manifestation were mainly chest pain , chest depressed , cough ,dyspnea and pleural effusion. 14 cases had pleural effusion under X-ray and pleural anomaly thickening or nodules were found in 26 cases on CT examination. Of all the diagnosed cases, 18 cases were diagnosed via biopsy of pleura and cytologic examination in pieural effusion.(3)Most cases were only treated with operation , radio- therapy and chemotherapy while 3 cases were treated with combined therapy.
Conclusion
The patient with progressive chest pain ,cough and dyspnea,who also has pleural effusion ,pleural thickening or nodules on X-ray or CT examination should pay attention to the fact that maybe he has had pleural mesothelioma. Biopsy of pleura and cytologic examination in pieural effusion are the most important diagnoses measure.To malignant pleural mesothelioma,combined therapy is better than single means.
引文
[1] 郭静瑗1胸膜间皮瘤—胸膜活检证实5例报道并国内文献复习实用内科杂志，1983，3(4)：1861．
[2] 吴阶平，裘法祖．黄家驷外科学 第4版．北京：人民卫生出社，1979，1418～1419．
[3] Vogolzang NJ, Schuta SM, Iannucci AM, et al. Malignant mesothelioma, Cancer Invest, 1984,53:377.
[4] Antman KH, Blum RH, Greenberger J S, et al. Multimodality therapy for malignant mesothelioma based on a study of natural history. Am J Med, 1980,68:356.
[5] 中华结核和呼吸杂志编辑委员会．胸膜间皮瘤310例综合分析．中华结核和呼吸杂志，1990，13(4)：216．
[6] 窦建明，于世伦，卞春和，等．胸膜间皮瘤19例临床分析．中华肿瘤杂志，1998，20(5)：387．
[7] Kolber C, Souquet PJ, Geriniere L, et al. Spontaneous hydro2 pneumothorax disclosing malignant mesothelioma. Apropos of 2 cases.Rev Pneumol CLin, 1996,52 (1): 42～44
[8] Pass HI, Pogrebniak HW. Diagnostic approach. Curr Probl Surg,1993, 10 (5): 964.
[9] Martensson G, Hagmar B, Zet tergren L. Diagnosis and prognosis in malignant pleural mesothelioma: a prospective study. Eur J Re2 spir Dis, 1984,65 (3): 169-178.
[10] Boutin C. Thoracoscopy in malignant mesothelioma.Pneumologie,1959,43: 61.
[11] Boutin C, Schlesser M, Frenay C, et al. Malignant pleural mesot helioma. Eur Respir J, 1998, 12 (4): 972-981.
[12] Malle D, Valeri RM, Photiou C, et al. Significance of immunocytochemical expression of E2cadherin , N2cadherin and CD44 in serous effusions using liquid2based cytology. Acta Cytol, 2005, 49 (1): 11-16.
[13] Martini N, M cco rmack PM, Bains M S, et al. Pleural mesothelioma. Ann Tho rac Surg, 1987, 43: 113.
[14] Gordon W , Antman K, Breenberger J, et al. Radiation Therapy in the management of patients with mesothelioma. Int J Radiat Oncol Biol Phys, 1982, 8: 19.
[15] Sorensen PG, Bach F, Bork E, et al. Randomized trial of doxorubicin versus cyclophosphamide in diffuse malignant pleural mesothelioma. Cancer TreatRep, 1985, 69(12): 1431-1432.
[16] Berghmans T, PaesmansM, Lalami Y, et al. Activity of chemo- therapy and immunotherapy on malignant mesothelioma : A systematic review of the literature with meta-analysis. Lung Cancer, 2002, 38: 111.
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[2] 吴阶平，裘法祖．黄家驷外科学 第4版．北京：人民卫生出社，1979，1418～1419．
[3] Vogolzang NJ, Schuta SM, Iannucci AM, et al. Malignant mesothelioma, Cancer Invest, 1984,53:377.
[4] Antman KH, Blum RH, Greenberger J S, et al. Multimodality therapy for malignant mesothelioma based on a study of natural history. Am J Med, 1980,68:356.
[5] 中华结核和呼吸杂志编辑委员会．胸膜间皮瘤310例综合分析．中华结核和呼吸杂志，1990，13(4)：216．
[6] 窦建明，于世伦，卞春和，等．胸膜间皮瘤19例临床分析．中华肿瘤杂志，1998，20(5)：387．
[7] Kolber C, Souquet PJ, Geriniere L, et al. Spontaneous hydro2 pneumothorax disclosing malignant mesothelioma. Apropos of 2 cases.Rev Pneumol CLin, 1996,52 (1): 42～44
[8] Pass HI, Pogrebniak HW. Diagnostic approach. Curr Probl Surg,1993, 10 (5): 964.
[9] Martensson G, Hagmar B, Zet tergren L. Diagnosis and prognosis in malignant pleural mesothelioma: a prospective study. Eur J Re2 spir Dis, 1984,65 (3): 169-178.
[10] Boutin C. Thoracoscopy in malignant mesothelioma.Pneumologie,1959,43: 61.
[11] Boutin C, Schlesser M, Frenay C, et al. Malignant pleural mesot helioma. Eur Respir J, 1998, 12 (4): 972-981.
[12] Malle D, Valeri RM, Photiou C, et al. Significance of immunocytochemical expression of E2cadherin , N2cadherin and CD44 in serous effusions using liquid2based cytology. Acta Cytol, 2005, 49 (1): 11-16.
[13] Martini N, M cco rmack PM, Bains M S, et al. Pleural mesothelioma. Ann Tho rac Surg, 1987, 43: 113.
[14] Gordon W , Antman K, Breenberger J, et al. Radiation Therapy in the management of patients with mesothelioma. Int J Radiat Oncol Biol Phys, 1982, 8: 19.
[15] Sorensen PG, Bach F, Bork E, et al. Randomized trial of doxorubicin versus cyclophosphamide in diffuse malignant pleural mesothelioma. Cancer TreatRep, 1985, 69(12): 1431-1432.
[16] Berghmans T, PaesmansM, Lalami Y, et al. Activity of chemo- therapy and immunotherapy on malignant mesothelioma : A systematic review of the literature with meta-analysis. Lung Cancer, 2002, 38: 111.
[1] Price B. Analysis of current trends in United States mesothelioma incidence. AmJ Epidemiol, 1997, 145: 211-218.
[2] Montanaro F, Bray F, Gennaro V, et al. Pleural mesothelioma incidence in Eur-ope: evidence of some deceleration in the increasing trends. Cancer Causes Control, 2003, 14: 791-803.
[3] Peto R, Darby S, Deo H, et al. Somking, smoking cessation, and lung cancer in the UK since 1950: Combination of national statistics with two case-control studies. BMJ, 2000, 321: 323-329.
[4] Stanton MF, Layard M, Tegeris A, et al. Relation of particle dimention to carcinogenicity of amphibole asbestos and other fibours minerals. J Natl Cancer inst, 1981, 67: 965-975.
[5] Newhouse ML, Berry G, Wagner JC. Mortlity of factory workers in east London 1933-1980. Br J Ind Med, 1985, 42: 4-11.
[6] Pass HI, Donington JS, Wu P, et al. Human mesotheliomas contain the simian virus240 regulatory region and large tumor antigen DNA sequences. J. Thorac Cardiovasc Surg, 1998, 116: 854-859.
[7] Cicala C, Pompetti F, Carbone M. SV40 induces mesothelilmas in hamsters. AmJ Pathol, 1993, 142: 1524-1533.
[8] Mayall FG, Jacobson G, Wilkins R. Mutations of p53 gene and SV40 sequences in asbestos associated and non-asbestos-associated mesothelioma. J Clic Pathol, 1999, 52: 291-293.
[9] Puntoni R, Filiberti F, Cerrano PG, et al. Implementation of a molecular epidemiology approach to human pleural malignant mesothelioma. Mutation Pes, 2003, 544: 385-396.
[10] De Perrot M, Fischer S, Brundler MA, et al. Solitary fibrous tumors of the pleura. Ann Thorac Surg, 2002,74:285～293.
[11] Roberts JR. Surgical treatment of mesothelioma : pleurectomy. Chest, 1999,116(6):446-449.
[12] 张敦华主编．实用胸膜疾病学．第1版．上海：上海医科大学出版社，1997，271-277．
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