Cicenas Saulius, Zaremba Sigitas, Jakubauskiene Renata
Institute of Oncology, Vilnius University, Santariskiu 1, 2021 Vilnius, Lithuania.
Medicina (Kaunas). 2004;40 Suppl 1:152-5.
Objective of our work was to evaluate: incidence, ethiology, diagnostic and treatment methods of malignant pleural mesothelioma.
During period 1992-2001 125 cases of pleural mesothelioma were diagnosed in Lithuania. Conventional X-rays and ultrasound were used in 125 cases (100%), chest CT scans in 57 (45.6%), and chest X-rays and CT scans in 38 (30.4%) cases. In 5 cases (4.0%) we performed chest CT scans and MRI. Various surgical diagnostic methods were used: videothoracoscopy in 35 (28.0%) cases, pleural biopsies 72 (57.6%) cases, diagnostic "mini" thoracotomies - 18 (14.4%) cases. Malignant pleural mesothelioma in all cases was proved morphologically. These operations were performed: pleuropulmonectomies - 62 (60.1%), extended pleuropulmonectomies with resections of pericardium and subtotal diaphragm - 10 (9.7%), parietal pleurectomies without resection of lung and pericardium - 17 (16.5%), partial pleurectomies with resection of pericardium - 4 (3.8%), debulking of tumor (partial resections) - 10 (9.7%). Totally 103 patients were operated (82.4%). Twenty two patients were treated conservatively when diagnosis was confirmed. There were such main postoperative complications: fistulas of bronchial stump - 6 cases (5.8%), chylothorax - 5 cases (4.8%), injury of sympatic ganglion - 2 cases (1.9%), and hemothorax - 10 cases (9.7%); 3 patients (2.91%) died after operation.
Mean survival time after combined treatment was 12+/-2 months. After conservative treatment alone - 6.0+/-2 months. In combined treatment group 22 patients (17.6%) had recurrence of disease during 3 years. In conservative treatment group no one survived 3 years.
Combined surgical treatment of malignant pleural mesothelioma is still the most effective. Most of diagnosed cases were found in delayed stage. Mean survival time after combined treatment is 12.0+/-2 months, after conservative - 6.0+/-2 months, and recurrence of the disease during 3 years - 17.6% and 100% respectively.
我们研究的目的是评估恶性胸膜间皮瘤的发病率、病因、诊断和治疗方法。
1992年至2001年期间，立陶宛诊断出125例胸膜间皮瘤。125例（100%）患者采用了传统X线和超声检查，57例（45.6%）进行了胸部CT扫描，38例（30.4%）进行了胸部X线和CT扫描。5例（4.0%）患者进行了胸部CT扫描和MRI检查。采用了多种手术诊断方法：35例（28.0%）进行了电视胸腔镜检查，72例（57.6%）进行了胸膜活检，18例（14.4%）进行了诊断性“小”开胸手术。所有病例的恶性胸膜间皮瘤均经形态学证实。实施了以下手术：胸膜肺切除术62例（60.1%），扩大胸膜肺切除术（切除心包和部分膈肌）10例（9.7%），不切除肺和心包的壁层胸膜切除术17例（16.5%），切除心包的部分胸膜切除术4例（3.8%），肿瘤减瘤术（部分切除术）10例（9.7%）。共有103例患者接受了手术（82.4%）。确诊后，22例患者接受了保守治疗。主要的术后并发症如下：支气管残端瘘6例（5.8%），乳糜胸5例（4.8%），交感神经节损伤2例（1.9%），血胸10例（9.7%）；3例患者（2.91%）术后死亡。
综合治疗后的平均生存时间为12±2个月。单纯保守治疗后的平均生存时间为6.0±2个月。在综合治疗组中，22例患者（17.6%）在3年内疾病复发。在保守治疗组中，无人存活3年。
恶性胸膜间皮瘤的联合手术治疗仍然是最有效的。大多数确诊病例发现时已处于晚期。综合治疗后的平均生存时间为12.0±2个月，保守治疗后的平均生存时间为6.0±2个月，疾病在3年内的复发率分别为17.6%和100%。
