Murdzhev K, Uchikov A, Iankulov A, Paskalev G
Khirurgiia (Sofiia). 2007(4):23-6.
Mesothelioma is characterized by aggressive follow-up, difficult diagnosis and treatment fatal issue. In one side the restricted possibility for operative treatment and the other side the resistance of tumors for chemotherapy are the mean reasons for bad results in patients with malignant pleural mesothelioma. We have aim to make a retrospective study of patients with malignant pleural mesothelioma in 3-th and 4-th stage, undergoing operation in our clinic and see VATS effectiveness.
In the clinic of thoracic surgery in University Hospital "St.George" - Plovdiv we made retrospective study in 21 patients undergoing operation in the occasion of advanced pleural mesothelioma. It was thoroughly men (14) in age between 45-72 years (58.6). In 18 (85%) patients the disease was proven intraoperative or on the final histological result after operation. Before operation in this patients in help of diagnosis, we have information by image examination (radiography, CT of thorax and if it necessary to mark pleural effusion - sonography of pleural cavity ) abdominal sonohography or CT of abdomen for exclusion of distant metastasis, fibrobronchoscopy (FBS) for confirmation or exclusion of endobronchial cancer and transthoracic aspiration biopsy (TTAB).
We describe improvement in the most of patients. In 2 patients we have not improvement. In this situation we made Bulao drainage. Death issue in early postoperative period we have in 1 patient with increased breath insufficiency despite evacuation of pleural effusion and unfolded lung.
Early diagnosis of malignant pleural mesothelioma is difficult, in some times impossible. After histological verification the diagnosis is proven. Image examination is still insufficient. The difficulty comes by insufficient cytologic and histologic verification before operation and also insufficiency of image examination. Because of the chemotherapy is insufficient, surgical treatment (radical or not) in huge number of cases help improvement of patient's condition.
间皮瘤的特点是随访过程棘手、诊断困难且治疗预后不佳。一方面，手术治疗的可能性有限，另一方面，肿瘤对化疗具有耐药性，这是恶性胸膜间皮瘤患者治疗效果不佳的主要原因。我们旨在对我院接受手术治疗的Ⅲ期和Ⅳ期恶性胸膜间皮瘤患者进行回顾性研究，观察电视辅助胸腔镜手术（VATS）的疗效。
在普罗夫迪夫“圣乔治”大学医院胸外科，我们对21例因晚期胸膜间皮瘤接受手术的患者进行了回顾性研究。患者均为男性（14例），年龄在45至72岁之间（平均58.6岁）。18例（85%）患者的疾病在术中或术后最终组织学结果得以证实。在这些患者术前诊断过程中，我们通过影像检查（胸部X线、胸部CT，必要时标记胸腔积液——胸腔超声检查）、腹部超声或腹部CT排除远处转移，通过纤维支气管镜检查（FBS）确认或排除支气管内癌，并进行经胸穿刺活检（TTAB）。
我们观察到大多数患者病情有所改善。2例患者病情未改善，对此我们进行了胸腔闭式引流。术后早期有1例患者尽管胸腔积液已排出且肺已复张，但呼吸功能不全加重，最终死亡。
恶性胸膜间皮瘤早期诊断困难，有时甚至无法诊断。经组织学验证后诊断得以确立。影像检查仍显不足。困难在于术前细胞学和组织学验证不充分以及影像检查不足。由于化疗效果不佳，大量病例中的手术治疗（根治性或非根治性）有助于改善患者病情。
