22例恶性胸膜间皮瘤的诊断与分析

胸膜间皮瘤为少见的胸膜原发肿瘤，起源于胸膜间皮细胞或胸膜下结缔组织，可分为弥漫型及局限型二种类型。其临床症状不典型，诊断困难，易造成误诊，大部分病例最终依靠胸膜活检。本文将我院自1993年11月至2004年12月收治的22例恶性胸膜间皮瘤进行分析，报告如下。     

弥漫型胸膜间皮瘤21例误诊分析

胸膜间皮瘤分局限型与弥漫型两大类。弥漫型胸膜间皮瘤因其临床表现无特异性，与结核性胸膜炎及其他恶性胸腔积液难以鉴别，极易误诊。1993～2004年，我院共收治了21例恶性胸膜间皮瘤，均首诊误诊。现将误诊原因分析并报告如下。     

恶性胸膜间皮瘤43例临床分析

目的回顾性分析43例恶性胸膜间皮瘤的临床特点，以提高恶性胸膜间皮瘤的诊治水平。方法分析43例胸膜间皮瘤的临床资料，包括年龄、石棉接触史、临床表现、影像学检查、实验室检查，用Kaplan—Meier模型的log—rank检验分析年龄、性别、侵犯范围、分期和汾疗方式等因素与预后的关系，用Cox模型分析影响预后的独立危险因素。结果43例患者均无明确石棉接触史；24例患者曾被误诊为结核性胸膜炎。43例均有不规则胸膜增厚。弥漫性增厚者共36例，局限性胸膜增厚有7例。40例可见纵隔胸膜受累，2例胸水中查到恶性间皮细胞。43例弥漫性恶性胸膜间皮瘤患者的中位生存时间为637月（范围0．23～90．30月），在单因素生存分析中，用单因素生存分析，侵犯范围、年龄和分期与预后相关，多因素Cox回归模型分析发现，局限型恶性胸膜间皮瘤预后较好。结论胸膜活检及免疫组化是确诊恶性胸膜间皮瘤的主要方法，侵犯范围是预后的独立影响因素。     

恶性胸膜间皮瘤治疗新进展

恶性胸膜间皮瘤是一种胸膜恶性肿瘤,已发现其发生与石棉暴露有关.目前治疗恶性胸膜间皮瘤的方法有手术治疗、化疗和放疗,但效果均不理想.外科手术由于缺乏随机对照研究,其效果仍不确切.放疗因为恶性间皮瘤细胞的放射敏感性一般.故也存在争议.化疗对恶性胸膜间皮瘤的治疗效果相对较差.联合应用培美曲唑与顺铂能达到较好效果.多模式治疗方案被认为是目前治疗恶性胸膜间皮瘤的首选.     

恶性胸膜间皮瘤19例临床分析

目的 总结经手术病理证实的21例恶性胸膜间皮瘤的临床诊断经验.方法 分析21例恶性胸膜间皮瘤的临床资料,包括有无石棉粉尘接触史、临床表现、影像学检查、特殊检查、胸水检测和有无转移,并对比15例手术结果.结果 8例患者工种与接触石棉有关,占恶性胸膜间皮瘤38.1％ (8/21),18例(85.7％)有胸痛,其中17倒(80.9％)伴胸腔积液,1例出现Horner综合症并影响臂丛神经.3例(19.1％ )CT下穿刺找到间皮瘤细胞.2例(9.6％)胸水中找到间皮瘤细胞,1例锁骨上淋巴结穿刺找到间皮瘤细胞.16例CT发现胸膜增厚或胸膜上结节样病灶,占恶性弥漫性胸膜间皮瘤76.2％.17例手术病例中12例胸膜广泛增厚或胸壁上广泛不规则太小不等结节融合成片.结论 石棉接触史是恶性胸膜间皮瘤发病的主要病因,胸痛、胸腔积液是主要临床表现.CT对诊断胸膜间皮瘤有重要参考价值,CT引导下活检能提高临床诊断率.     

CT在恶性胸膜间皮瘤诊断中的价值

目的探讨CT在恶性间皮瘤诊断中的价值。方法回顾分析9年来我院经手术或/和病理证实的42例恶性胸膜间皮瘤的CT表现，并与12例手术所见作了比较。结果结节状或肿块状胸膜增厚（97．6％）是胸膜间皮瘤最常见的CT表现，有诊断性的表现为胸膜增厚〉1cm（59．5％），环状胸膜增厚（41．5％），病变累及纵隔胸膜（92．9％）或叶间裂（69．0％），病变侵犯周围胸壁或／和肋骨、纵隔、心包、膈肌等邻近组织或器官（65．9％），1例呈胸内巨大肿块，42．9％病例可见纵隔或，和肺门淋巴结肿大。在CT和手术所见的比较中，CT正确检出了65％的对周围组织或器官的侵犯，漏诊的有35％。结论CT在恶性胸膜间皮瘤的诊断、分期上有重要价值，是治疗前的标准诊断方法。     

恶性胸膜间皮瘤的临床特点及鉴别诊断

目的探讨恶性胸膜间皮瘤的临床特点及其鉴别诊断。方法对山东省胸科医院2009年1月至2013年12月确诊的30例恶性胸膜间皮瘤及同期住院的30例肺腺癌胸膜转移及30例结核性胸膜炎的临床表现,影像学特点,实验室检查,胸腔镜下表现进行对比和分析。结果恶性胸膜间皮瘤的临床症状同结核性胸膜炎及肺腺癌胸膜转移组患者相比缺乏特异性。影像学表现中环状胸膜增厚,病侧肺容积小,纵隔固定在恶性胸膜间皮瘤中相对常见。实验室检查中恶性胸膜间皮瘤无特异性检查指标,肺腺癌胸膜转移患者血及胸水癌胚抗原(CEA)明显升高,胸水找肿瘤细胞阳性率高;结核性胸膜炎胸水腺苷酸脱氨酶是相对特异性指标。胸腔镜下表现中恶性胸膜间皮瘤主要表现为弥漫胸膜增厚及大小不等的结节,有的呈大的肿块样改变,质地相对较硬。肺腺癌胸膜转移主要表现为不同程度的胸膜增厚及孤立或多发小结节,部分可融合呈桑葚或菜花状,易于取病理。结核性胸膜炎以充血、水肿,黏连和分隔,包裹为主要表现,可见有粟粒状小结节分布。胸腔镜多点取材并行免疫组化各组病例均明确诊断。结论恶性胸膜间皮瘤临床表现缺乏特异性,易于误诊为肺腺癌胸膜转移及结核性胸膜炎,内科胸腔镜检查可准确诊断恶性胸膜间皮瘤等胸膜疾病,减少误诊。     

恶性胸膜间皮瘤50例诊断分析

目的探讨恶性胸膜间皮瘤的临床特点、经皮胸膜活检术对恶性胸膜间皮瘤的诊断价值。方法回顾性分析我院收治的50例恶性胸膜间皮瘤患者的临床资料。结果有石棉接触史者21例。顽固性胸痛23例,占46．0％,气促28例,占56．0％,43例行胸膜活检,特异性病理诊断25例,胸膜活检阳性率58．14％,11例行开胸活检,占22．0％,胸腔镜检查确诊7例,占14．0％,5例行CT引导穿刺活检,占10．0％。结论顽固性胸痛、气促是胸膜间皮瘤的主要临床表现,经皮胸膜活检对诊断恶性胸膜间皮瘤具有重要的临床价值,阳性率达58．14％,是确定病理诊断的有效方法。     

多层螺旋CT鉴别恶性胸膜间皮瘤与胸膜转移瘤的应用价值

目的 探讨多层螺旋CT鉴别恶性胸膜间皮瘤与胸膜转移瘤的应用价值分析。方法 选取我院自2017年5月-2021年5月经病理学确诊的30例原发恶性胸膜间皮瘤及30例胸膜转移瘤患者的多层螺旋CT检查资料进行回顾性影像学分析。结果 恶性胸膜间皮瘤患者与胸膜转移瘤患者CT表现环状胸膜增厚、叶间胸膜受累情况、胸膜斑、肺门及纵隔淋巴结肿大、胸廓体积缩小、心包受累、肺内转移情况,两者差异显著(P<0.05);胸腔积液、胸壁受累情况无显著差异(P>0.05)。结论 环形胸膜增厚、叶间胸膜块状增厚、胸膜斑、患侧胸廓体积缩小、心包受累有利于恶性胸膜间皮瘤的诊断,而叶间胸膜多发小结节状转移,肺门及纵隔淋巴结肿大、肺内转移有利于胸膜转移瘤的诊断。     

电子胸腔镜下恶性胸膜间皮瘤的表现及其诊断价值

目的观察恶性胸膜间皮瘤（MPM）患者胸腔镜下的表现,评价胸腔镜对MPM的诊断价值。方法回顾性分析20例经内科电子胸腔镜确诊的MPM患者胸膜病变（镜下形态和分布特点）。结果MPM胸腔镜下主要有三种形态：10例（50％）外观表现为弥漫性大小不等的黄红色结节样隆起,呈半透明状,典型者如桑椹状;4例（20％）肉瘤型,病变局限,呈黄白色乳头状或息肉状;6例（30％）表现为胸膜广泛增厚,颜色灰白,质地较硬。病变分布：20例患者中16例病变呈弥漫性分布（占80％）;脏层胸膜2例（占10％）;膈胸膜2例（占10％）。无1例发生严重并发症。结论电子胸腔镜检查安全高效,在恶性胸膜间皮瘤的诊断中具有重要的应用价值。     

Clinical implications of unexpandable lung due to pleural disease

Unexpandable lung due to pleural disease may manifest itself as a hydropneumothorax after pleural drainage procedure or as an inability to completely drain a pleural effusion due to chest pain. The condition is a mechanical complication of a variety of pleural disorders. Of these, malignant lung entrapment and inflammatory lung entrapment are considered complications of active pleural disease, and management is primarily dependent on the nature of the active process. Trapped lung is a sequela of remote inflammation of the pleural space. Trapped lung is usually asymptomatic but may be the cause of dyspnea in some patients. The only available treatment of symptomatic trapped lung is surgical decortication. Surgical decortication should only be considered after other causes of dyspnea have been excluded.     

胸部疾病外科治疗52例临床分析

目的探讨胸部疾病（以结核、肿瘤、炎症居多）通过外科手术治疗的必要性和重要性,提高其确诊率和治愈率。方法对我院06年7月至07年4月采用胸外科手术治疗的52例病案进行分析,总结其诊断及治愈情况。结果无手术死亡,1例左肺小细胞癌术后随访1年死亡,恶性胸膜间皮瘤术后随访10月死亡,其余50例患者目前均恢复健康。肺结核、胸壁结核、结核性胸膜炎等术后无一例复发及并发症发生。结论胸部疾病多以内科治疗为主,经内科诊治无法确诊并有外科手术指证者,特别是胸部结核性疾病内科治疗效果不理想者,极易误诊或延误治疗。手术是一种极其简便、有效的治疗手段。     

Assessment of 18F-fluorodeoxyglucose dual-head gamma camera in asbestos lung diseases.

The purpose of this study was to evaluate the performance of 18F-fluorodeoxyglucose (18FDG) imaging via coincidence detection emission tomography (CDET) in identifying malignant lesions in subjects exposed to asbestos. A total of 30 patients exposed to asbestos underwent 18FDG-CDET between January 2000 and June 2003. A CDET scan of the thorax and abdomen was performed 60 min after injection of 18FDG in fasting patients, and results were obtained in slices in three axes. The CDET results were compared to those from computed tomography (CT), and pleural or surgical biopsy in patients with positive 18FDG-CDET results. All primary malignant mesotheliomas accumulated 18FDG (n=6), and, in two patients, CDET findings were superior to those of CT, allowing early detection. In two cases, lung carcinomas with malignant pleural effusion were also detected. There were five false positive CDET results: three unilateral pleural thickening, one rounded atelectasis, and one benign lung nodule. All patients with pleural plaques showed no significant 18FDG uptake. Malignant diseases were detected by 18FDG-CDET imaging with a sensitivity of 89% and specificity of 71%. Coincidence detection emission tomography can identify malignant mesothelioma in selected subjects exposed to asbestos. Coincidence detection emission tomography appears to be a useful noninvasive method for the follow-up of subjects with exposure risk of asbestosis.     

Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey. Analysis of 135 cases.

We reviewed data from 135 patients with environment-associated malignant pleural mesothelioma (MPM) from the Central Anatolian region of Turkey. The most significant factors suggesting the diagnosis of MPM were the village where the patient resided and the typical presenting symptoms and signs of unilateral exudative pleural effusion associated with nonpleuritic chest pain. Computed tomography and ultrasonography were very useful for evaluating the extension of the tumor in the thoracic and abdominal cavities and chest wall. The tissue diagnosis was established by either thoracoscopy (39 percent) or pleural biopsy (39 percent) in the majority of the cases. The median survival after diagnosis was 13.52 months for erionite-associated MPM and 21.56 months for asbestos-associated MPM. The actuarial survival curves for the fibrous minerals were significantly different for survival computed both from onset of the symptoms and after diagnosis. Medical or surgical treatment or both did not change the outcome of the disease.     

可弯曲式内科胸腔镜在恶性胸膜间皮瘤中的诊断价值

目的探讨可弯曲式胸腔镜对恶性胸膜间皮瘤的诊断价值。方法对30例不明原因胸腔积液患者进行胸腔镜检查。全麻下于腋部胸壁第6～7肋间置入胸腔镜套管,吸去大部分胸腔积液后按照内、前、上、后、侧、下的顺序观察胸膜腔并进行胸膜活检。结果 30例患者中有6例经直视下取活检病理证实为恶性胸膜间皮瘤。结论胸膜间皮瘤,单纯依靠影像学诊断较为困难,通过内科胸腔镜可在直视下取到理想的胸膜组织,提高了诊断阳性率。     

Percutaneous needle aspiration biopsy of chest lesions. New instrument and new technique

From March 1986 to April 1987, 70 percutaneous needle aspiration (PCNA) procedures were performed in 66 consecutive patients. Seven immunocompromised patients had the procedure performed to obtain culture material from the lung, and 59 patients with chest lesions were analyzed. This includes 49 patients with either a lung nodule or mass. In the remaining ten patients, there were three chest wall or pleural lesions, two aortic pulmonary window lesions, two right hilar lesions, and three anterior mediastinal lesions. Forty of these 59 patients were ultimately proven to have a malignancy. The diagnostic yield for malignant disease by cytology and histology of PCNA was 97.5 percent (39 of 40). Twelve patients had a final diagnosis of benign disease. The diagnostic yield in benign diseases by PCNA was 91.6 percent (11 of 12). The remaining seven patients do not yet have a final diagnosis, though the clinical course favors benign disease in six of these patients. We attribute the major reason for this high specific diagnostic yield in both malignant and benign diseases to the ability of obtaining histologic specimens for interpretation.     

A case of malignant mesothelioma showing rapid progression during one month]

A 57-year-old man with massive right pleural effusion was admitted to our hospital. Thoracoscopy revealed, fine granulations and small nodules scattered on the parietal pleura. Biopsy specimens suggested malignant mesothelioma. We performed thoracoscopy again one month later under general anesthesia to make a definitive diagnosis. At that time, the parietal pleura was covered with a large tumor and malignant mesothelioma was diagnosed by biopsy. We could find early pleural lesions of malignant mesothelioma in thoracoscopy. While we managed to make a definitive diagnosis, the tumor progressed rapidly during one month. If malignant pleural mesothelioma is suspected, it is necessary to make all efforts, including surgical biopsy, to diagnose during the early stage of disease.     

甲型H1N1流感的病原学与流行病学

目的：通过临床病例分析，了解肺内神经鞘瘤的临床和影像表现，提高鉴别诊断能力。方法：对1979年1月－2001年10月期间收治的7例肺内神经鞘瘤的临床、影像学表现及诊断依据进行分析。结果：主要症状：小量咯血、咳嗽、发热、气促、胞痛。纤维支气管镜检查：支气管腔内见新生物3例，外压性狭窄2例。影像表现：左总支气管腔内见结节阻塞2例；肺内单发肿块4例；多发肿块1例（2个病灶）。肿块边缘光整3个（良性2个，恶性1个），毛糙3个（恶性）。CT增强扫描，表同为网格样强化1个（良性）、周边强化1个（恶性）、不均质强化4个（良性1个，恶性3个）。伴支气管和肋骨受压2例。恶性神经鞘瘤中见胸膜浸润伴胸液1例、血管受侵2例。结论：肺内神经鞘瘤罕见，临床及影像学表现缺乏特异性。肿瘤大小和密度对良恶性鉴别无特征意义，肿瘤边界不光整提示恶性可能，相邻结构侵犯是提示恶性病变的重要征象。     

Metastatic renal cell carcinoma presenting as multiple pleural tumours

A 66-year-old man was admitted with dyspnoea. Chest X-ray and chest computed tomography (CT) demonstrated a left-sided pleural effusion and multiple tumours, suggesting malignant mesothelioma in the left pleural space, but there were no pulmonary lesions. However, abdominal CT revealed a right renal tumour. An ultrasonography-guided needle biopsy of the pleural mass provided evidence of metastatic renal cell carcinoma (RCC). The pleural lesions dramatically decreased in size following right radical nephrectomy and subsequent interferon-alpha treatment. While the thorax is a frequently affected site of RCC, sole pleural metastases are rare and are often secondary to lung involvement. Batson's plexus, a network of vertebral valve-less veins with multiple connections, is likely responsible for the contralateral pleural metastases of RCC.     

胸腔置管引流并给药治疗恶性胸腔积液的临床疗效

目的探讨恶性胸腔积液置管引流并给药物的临床疗效。方法对60例恶性胸腔积液病人应用中心静脉导管胸腔穿刺置管引流,将顺铂（DDP）稀释后注入胸腔内治疗,每周2次。结果完全缓解（CR）19例,部分缓解（PR）32例,总有效率（CR＋PR）85％,不良反应轻,以消化道和一过性发热胸痛为主要反应。结论该方法安全,简便,易行,胸腔内给药不良反应少,能有效控制恶性胸液生长,对缓解病情具有积极的临床意义。