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目的:探讨恶性间皮瘤的临床病理特点。方法:收集1985~2014年四川省肿瘤医院24例恶性间皮瘤患者的临床资料,回顾性分析患者的临床特点。结果:24例恶性间皮瘤患者中恶性胸膜间皮瘤18例,恶性腹膜间皮瘤6例;男17例,女7例,中位年龄52岁。恶性胸膜间皮瘤最常见症状为胸痛(7例),活动后气促(6例)。恶性腹膜间皮瘤最常见症状为腹胀(3例)。影像学特征最常见为胸腔或腹腔积液(14例)。胸、腹腔镜或剖胸、剖腹探查术确诊17例,胸壁或皮下包块活检术确诊5例,经胸水免疫细胞化学确诊2例。病理学分型:上皮型20例,混合型2例,未分型2例。初诊时7例患者误诊(29.2%),4例患者确诊前接受抗痨治疗(16.7%)。从发病到确诊中位时间3.3个月。21例患者接受化疗,1例行根治性手术,8例行姑息性手术,5例姑息性放疗。确诊至随访期结束中位生存时间为21个月。结论:恶性间皮瘤起病隐匿,确诊时多为局部晚期,无法行根治性手术,治疗以手术,放化疗多学科综合治疗为主,可改善症状,适当延长生存。
Objective: To investigate the clinicopathological features of malignant mesothelioma. Methods: The clinical data of 24 patients with malignant mesothelioma from 1985 to 2014 in Sichuan Cancer Hospital were collected. The clinical features of the patients were retrospectively analyzed. Results: Among 24 patients with malignant mesothelioma, 18 had malignant pleural mesothelioma and 6 had malignant peritoneal mesothelioma. There were 17 males and 7 females, with a median age of 52 years. Malignant pleural mesothelioma is the most common symptom of chest pain (7 cases), shortness of breath after activity (6 cases). Malignant peritoneal mesothelioma is the most common symptom of bloating (3 cases). Imaging features most commonly pleural or ascites (14 cases). Chest, laparoscopy or thoracotomy, laparotomy diagnosed in 17 cases, 5 cases were diagnosed by chest wall or subcutaneous mass biopsy, and 2 cases were confirmed by immunocytochemistry of pleural effusion. Pathological type: epithelial type 20 cases, mixed type in 2 cases, not type 2 cases. Seven patients were misdiagnosed (29.2%) at initial diagnosis and four received anti-tuberculosis treatment (16.7%) prior to diagnosis. From onset to the median diagnosis of 3.3 months. Twenty-one patients underwent chemotherapy, one underwent radical surgery, eight patients underwent palliative surgery and five patients underwent palliative radiotherapy. The median survival time at diagnosis up to the end of follow-up was 21 months. Conclusions: Malignant mesothelioma is occult onset. Most of the diagnosed mesotheliomas are locally advanced. Radical mesothelioma can not be treated by radical surgery. The treatment is mainly multidisciplinary with surgery and radiotherapy and chemotherapy, which can improve symptoms and prolong survival.