Iyoda A, Miyamoto H, Sakao Y, Harada R, Hamada T, Hata E
Department of Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1995 Jun;43(6):889-93.
We report a case of diffuse malignant mesothelioma discovered by thoracoscopic examination undertaken while formulating a preoperative diagnosis. A 61-year-old male complained of coughing and sputum production, and was admitted because his chest roentgenogram indicated an abnormal shadow. Chest CT scanning demonstrated right pleural effusion and multiple nodules sited on the diaphragm. Because aspiration biopsy of such nodules was difficult, we performed a thoracoscopic examination. The thoracoscopic findings demonstrated bloody pleural effusion in the right thoracic cavity and multiple nodules on the diaphragm, parietal and pulmonary pleura. They were white and 0.5 to 2 cm in size. By excisional biopsy, these were diagnosed as epithelial-type diffuse malignant mesothelioma. We therefore performed panpleuropneumonectomy. Even though we completely resected the canal of thoracoscope and drainage tube, microscopic findings showed invasion of mesothelioma cells into this thoracoscopic canal. Although we suggest that, in preoperative diagnosis of pleural tumor, thoracoscopy is efficient to perform a pathological examination and confirm the extension of tumor, in the actual operation, we believe that the thoracoscopic canal should be resected.
我们报告一例在术前诊断过程中通过胸腔镜检查发现的弥漫性恶性间皮瘤病例。一名61岁男性主诉咳嗽、咳痰，因胸部X线片显示异常阴影而入院。胸部CT扫描显示右侧胸腔积液及膈肌上多个结节。由于对这些结节进行穿刺活检困难，我们进行了胸腔镜检查。胸腔镜检查发现右侧胸腔有血性胸腔积液，膈肌、壁层胸膜和脏层胸膜上有多个结节。它们呈白色，大小为0.5至2厘米。通过切除活检，诊断为上皮型弥漫性恶性间皮瘤。因此我们进行了全胸膜肺切除术。尽管我们完全切除了胸腔镜通道和引流管，但显微镜检查结果显示间皮瘤细胞侵入了这个胸腔镜通道。虽然我们认为，在胸膜肿瘤的术前诊断中，胸腔镜对于进行病理检查和确认肿瘤范围是有效的，但在实际手术中，我们认为胸腔镜通道应该切除。
