恶性胸膜间皮瘤的外科治疗

目的　恶性胸膜间皮瘤的治疗尚无统一方案 ,手术切除仍是主要的治疗手段。本文探讨了恶性胸膜间皮瘤的手术方式、手术指征 ,以及影响术后生存的因素。方法　收集本院自 1985年以来手术治疗的恶性胸膜间皮瘤患者的资料 ,对临床表现、TNM分期、细胞类型、手术方式、生存期等分析 ,研究胸膜外全肺切除和胸膜切除两种不同手术方式以及不同分期、不同细胞类型对预后的影响。结果　 33例手术治疗者中胸膜外全肺切除术 16例 ,胸膜切除术 17例 ,总中位生存期为 2 1个月 ,2年生存率和 5年生存率分别为 36 .6 %和 13.3% ,不同手术方式之间术后生存期差异无显著性 ;不同TNM分期之间生存期差异有显著性 (P =0 .0 4 2 8)。结论　无论胸膜外全肺切除还是胸膜切除 ,都只能达到肉眼下的完全切除 ,可缓解症状 ,并为综合治疗创造条件。两种手术方式对预后的影响差异无显著性。早期诊断和尽早手术治疗是取得良好效果的关键。

Surgical therapy for malignant pleural mesothelioma

Objective There is no standard treatment for malignant pleural mesothelioma. However, surgical resection remains the mainstay of treatment. Present study is to evaluate the different types of resection, to discuss the indications of operation, and to identify prognostic factors that influence the postoperative survival. Methods A retrospective review was conducted on the records of 33 patients with malignant pleural mesothelioma who had received surgical treatment in Shanghai Chest Hospital. Data collected included clinical presentation, tumor type and involvement, type of resection, complication, and survival. Results Of the 33 patients, 16 underwent extrapleural pneumonectomy, 17 underwent pleurectomy decortication. The overall median survival was 21 months, 2-year survival and 5-year survival was 36.6% and 13.3% respectively. There was no significant difference between the two types of resection ( P =0.9152), however, there was significant difference between different TNM stages ( P =0.0428). Conclusion In most of cases, either extrapleural pneumonectomy or pleurectomy decortication can only attain gross-total resection. But surgical treatment can alleviate symptoms and facilitate the multimodality therapy. Two types of resection lead to equal survival for suitable patients. Early diagnosis and surgical treatment are critical for patients to attain good results.