44例恶性胸膜间皮瘤临床分析

目的　探讨恶性胸膜间皮瘤的临床特点。方法　回顾分析我院 1 990年 1月 - 2 0 0 3年 6月病理确诊的 4 4例恶性胸膜间皮瘤患者的临床资料。结果　本组病例男 2 6例、女 1 8例 ,男∶女为 1 44∶1 ;年龄以4 0～ 6 0岁多见 (占 4 3 % ) ;农民 1 5例 ,工人 7例 ,退休人员 5例 ,无业 5例 ,其他职业 6例。所有病例均无明显石棉接触史。首发症状胸痛 34例 ,活动后呼吸困难 31例 ,咳嗽 2 7例。 4 3例胸部X线表现为中 -大量积液 ,其中 1 0例伴胸膜广泛增厚 ;5例胸部CT检查显示胸膜增厚呈多发结节波浪状阴影。 38例胸腔穿刺抽液检查 ,其中 2 3例黄色胸液 ,1 5例为血性胸积液 ,31例积液的细胞分类计数淋巴细胞大于 5 0 %。 2 5例经胸膜针刺活检确诊 (5例胸液脱落细胞学检查同时找到恶性胸膜间皮瘤细胞 ) ;1 5例外科手术活检确诊。结论　恶性胸膜间皮瘤以胸痛、呼吸困难、咳嗽为主要表现 ,胸膜针刺活检为主要确诊方法。

The Clinical Analysis of 44 Cases of Patients with Malignant Pleural Mesothelioma

Objective To investigate the clinical characteristics of malignant pleural mesothelioma. Methods The clinical data of 44 patients with malignant pleural mesothelioma covering a period from 1999 to 2003 were retrospectively reviewed. Results Of all the 44 cases, 26 cases are male,18 cases are female. Male∶female=1 44∶1; Patients age were mostly from 40 to 60 (43 2%), among these patients,15 are peasant, 7 are worker, 5 are retired, 5 are out of work and 6 are the other profession. All the cases had no evidently history of exposure to asbestos. 34 patients had chest pain in their first clinical symptom, 31 patients had dyspnea after physical labor and 27 patients had clinically characteristic with cough. Through the radiologic findings, we could find 43 cases showing plenty of pleural effusion and with pleural thickening among 10 of them, and 5 pleural thicken cases were found multi-nodule wavelike shadow on CT examination. In the 38 analysis of pleural effusion cases, 23 cases were yellow, and 15 were blood-red, 31 case lymph cell classification count over 50% was detected. Of all the diagnosed cases, 25 cases were diagnosed via the needle biopsy of pleura (malignant pleural mesothelioma cell were found on cytologic examination in effusion of 5 cases); And 15 cases were diagnosed through the operation examination. Conclusion Chest pain, dyspnea, cough are always showed on malignant pleural mesothelioma cases, needle biopsy of pleura is the most important diagnosis measure.