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目的总结恶性腹膜间皮瘤的临床特点,提高诊治水平。方法对首都医科大学附属北京佑安医院2005年3月至2016年10月收治的6例经病理证实为恶性腹膜间皮瘤患者的临床资料进行回顾性分析,并复习相关文献。结果 6例患者中,男4例,女2例;合并乙肝肝硬化2例;临床表现以腹胀、腹痛、食欲下降为主,无发热、腹泻等症状;阳性体征主要是腹部质韧和腹水征,压痛和反跳痛不明显;腹腔积液检查提示白细胞数不同程度升高,肿瘤标志物仅发现CA125升高,中位值64.66 IU/ml;腹部CT均发现腹膜、肠系膜不均匀增厚。给予抗感染药物治疗,症状未缓解,5例患者经腹膜活检后明确诊断,1例经腹水细胞学检查明确。4例术后分别给予化疗和(或)放疗等,生存时间6~27个月;保守治疗2例,生存时间分别为1个月和3个月。结论恶性腹膜间皮瘤临床表现类似自发性腹膜炎,容易误诊,但是无发热和腹部压痛等症状,实验室常规检查无明显异常指标,抗感染治疗无效,及时获取腹膜标本方可明确诊断。一般预后较差,采取综合治疗手段可延长生存时间。
Objective To summarize the clinical features of malignant peritoneal mesothelioma and to improve the diagnosis and treatment. Methods The clinical data of 6 patients with malignant peritoneal mesothelioma confirmed by pathology in Beijing You’an Hospital Affiliated to Capital Medical University from March 2005 to October 2016 were analyzed retrospectively and relevant literatures were reviewed. Results Among the 6 patients, there were 4 males and 2 females with 2 cases of hepatitis B cirrhosis. The main clinical manifestations were abdominal distension, abdominal pain and loss of appetite, with no symptoms of fever and diarrhea. The positive signs were mainly abdominal tenderness and ascites , Tenderness and rebound tenderness was not obvious; ascites fluid examination showed different levels of leukocyte increased tumor markers found only increased CA125, median 64.66 IU / ml; abdominal CT were found in the peritoneum, mesenteric uneven thickening. Given anti-infective drug treatment, the symptoms did not alleviate, 5 patients after peritoneal biopsy clear diagnosis, 1 case of ascites cytology clear. Four patients were given chemotherapy and / or radiotherapy, respectively. The survival time ranged from 6 to 27 months. Two patients received conservative treatment. The survival time was 1 month and 3 months respectively. Conclusions The clinical manifestations of malignant peritoneal mesothelioma are similar to those of spontaneous peritonitis, which are easily misdiagnosed. However, there are no symptoms such as fever and tenderness in the abdomen. There are no obvious abnormal indexes in routine laboratory tests, and the anti - infective therapy is ineffective. Obtaining peritoneal samples in time can confirm the diagnosis. The general prognosis is poor, to take comprehensive treatment to extend the survival time.