發(fā)布時(shí)間：2018-05-17 03:34

  本文選題：惡性胸膜間皮瘤 + 臨床特征��； 參考：《北京協(xié)和醫(yī)學(xué)院》2015年碩士論文

【摘要】：背景 惡性胸膜間皮瘤(Malignant Pleural Mesothelioma,MPM)是一種較為罕見且具有高度侵襲性及強(qiáng)致死性的胸膜原發(fā)腫瘤,其來源于臟層、壁層、縱隔或橫膈四部分胸膜。近年來,惡性胸膜間皮瘤的發(fā)病率隨全球石棉的廣泛應(yīng)用而迅速增加。其臨床表現(xiàn)不典型,故診斷較為困難,常易漏診、誤診。MPM尚缺乏有效、規(guī)范的治療方法,不同的病理分型預(yù)后均較差。因此,惡性胸膜間皮瘤目前仍是醫(yī)療界較為棘手的難題。本研究的目的是探討惡性胸膜間皮瘤(Malignant Pleural Mesothelioma,MPM)的臨床特征及預(yù)后因素。方法 回顧性分析我院1990年1月至2013年12月收治的151例MPM患者的臨床資料,總結(jié)其臨床特征,并對性別、年齡、吸煙史、石棉接觸史、腫瘤家族史、有無胸痛、侵犯范圍、腫瘤分期、治療方式等進(jìn)行單及多因素預(yù)后分析。結(jié)果 151例患者中男95例(62.91%),女56例(37.09%),中位年齡52歲(16～78歲),有石棉接觸史4例(2.6%)。最常見的首發(fā)臨床表現(xiàn)為胸痛(64例,42.4%)。病程0.3～48個(gè)月,中位病程3個(gè)月。根據(jù)侵犯范圍分為局限型(43例,28.5%)和彌漫型(108例,71.5%)。確診方式包括術(shù)后病理確診80例(53.0%),開胸/胸腔鏡活檢40例(26.5%),經(jīng)皮穿刺腫物活檢18例(11.9%),胸水細(xì)胞學(xué)檢查13例(8.6%)。采用國際間皮瘤學(xué)會(huì)(International Mesothelioma Interest Group,IMIG)提出的TNM分期法對腫瘤進(jìn)行分期：Ⅰ期2例(1.3%),Ⅱ期22例(14.6%),Ⅲ期58例(38.4%),Ⅳ期69例(45.7%)。治療方式包括單純手術(shù)23例(15.3%),單純化療63例(41.7%),手術(shù)+輔助治療57例(37.7%),化療+放療8例(5.3%)。隨訪到133例患者,中位隨訪時(shí)間13.0月(0.3～158月),中位生存時(shí)間19.0月(95%置信區(qū)間11.5～26.5)。1、2、3及5年總生存率分別為60.0%、44.6%、36.0%和28.3%。單因素分析顯示性別(P=0.048)、侵犯范圍(P=0.005)、腫瘤分期(P=0.002)與預(yù)后相關(guān)。多因素分析顯示,性別(P=0.013)和腫瘤分期(P=0.001)是影響預(yù)后的獨(dú)立因素。結(jié)論 惡性胸膜間皮瘤發(fā)病率低,臨床表現(xiàn)不典型,易漏診、誤診,預(yù)后差。手術(shù)、化療、放療及綜合治療的療效均欠佳。性別及腫瘤分期是影響預(yù)后的獨(dú)立因素。
[Abstract]:Background malignant pleural mesothelioma Malignant Pleural Mesothelioma (MPM) is a rare, highly invasive and highly lethal primary pleural tumor originating from the four parts of pleura, including the visceral layer, the parietal layer, the mediastinum or the diaphragm. In recent years, the incidence of malignant pleural mesothelioma has increased rapidly with the wide application of asbestos worldwide. Its clinical manifestation is not typical, so it is difficult to diagnose, it is easy to miss diagnosis, misdiagnosis. MPM is still lack of effective, standardized treatment methods, the prognosis of different pathological classification is poor. Therefore, malignant pleural mesothelioma is still a difficult problem in medical field. The purpose of this study was to investigate the clinical features and prognostic factors of malignant pleural mesothelioma (Malignant Pleural Mesothelioma). Methods the clinical data of 151 patients with MPM from January 1990 to December 2013 were analyzed retrospectively, and the clinical features were summarized, including sex, age, history of smoking, history of asbestos exposure, family history of tumor, chest pain and the extent of invasion. Single and multivariate prognostic analysis was performed for tumor staging and treatment. Results among 151 patients, 95 males (62.91%) and 56 females (37.09%) had a median age of 52 years (1678 years), and 4 cases had a history of asbestos exposure (2.6%). The most common initial clinical manifestation was chest pain in 64 cases. The course of disease was 0.3 ~ 48 months and the median course was 3 months. According to the range of invasion, there were 43 cases of localized type and 108 cases of diffuse type. The methods of diagnosis included pathological diagnosis in 80 cases, thoracoscopic biopsy in 40 cases, percutaneous biopsy in 18 cases, and cytological examination of pleural effusion in 13 cases. The TNM staging method proposed by the International Mesothelioma Society (Imig) was used to stage the tumor: stage 鈪，

本文編號：1899735