恶性胸膜间皮瘤42例临床分析

目的:探讨恶性胸膜间皮瘤的临床特点。方法:回顾性选取42例恶性胸膜间皮瘤患者的资料进行分析。结果:临床症状主要有胸痛(64.3%),咳嗽(81%),呼吸困难(73.8%)等,均无明显石棉接触史。胸液均为渗出液,胸液腺苷脱氨酶(ADA):平均14.4U/L,胸液癌胚抗原(CEA):平均1.15ng/ml,癌抗原125(CA125):平均1 114.6U/ml,细胞角蛋白19片段(CYFRA21-1):平均116.4ng/ml。胸部影像学示42例均有胸腔积液,其中大量积液17例(40.5%),胸膜增厚31例(73.8%),胸膜结节或肿块影10例(23.8%),胸壁侵犯肋骨破坏2例(4.8%)。CT引导下经皮肺穿刺7例(16.6%),胸膜活检14次(33.3%),外科胸腔镜检查7例(16.7%),开胸手术活检13例(31%)。结论:恶性胸膜间皮瘤临床症状不典型,胸液肿瘤标志物CA125及CYFRA21-1均明显升高,胸部CT可提供重要的诊断依据,经皮肺穿刺及胸膜活检是确定病理诊断简便而有效的方法。

Clinical Analysis of 42 Patients with Malignant Pleural Mesothelioma

Objective:To explore the clinical features of malignant pleural mesothelioma.Methods:42 patients with malignant pleural mesothelioma were analyzed.Results:Their main clinical symptoms were chest pain(64.3%),cough(81%),dyspnea(73.8%),etc.They all had no significant history of asbestos exposure..Pleural fluid was exudative,and the leverl of ADA in pleural fluid was 14.4 U / L,CEA(1.15ng/mL),CA125 (1114.6U / mL),CYFRA21-l(116.4ng/mL).42 cases in imaging had pleural effusion,in which a large number of effusion in 17 patients(40.5%), pleural thickening in 31 cases(73.8%),pleural nodules or mass in 10 cases(23.8%),chest wall invasion and destruction of ribs 2(4.8%).To confirm diagnosis,percutaneous lung puncture guided by CT were used in 7 cases(16.6%),pleural biopsy inl4 cases(33%),surgical thoracoscopy biopsy in 7 cases(16.7),thoracic surgery biopsy in 13 cases(31%).Conclusion:The clinical symptoms of malignant pleural mesothelioma is not typical, and pleural fluid tumor marker CA125 and CYFRA2I-1 are significantly increased,and chest CT may provide an important basis for the diagnosis. Pathological diagnosis by percutaneous lung biopsy and pleural biopsy is a simple and effective method to confirm.