【摘要】 目的　经病理证实的 19例恶性胸膜间皮瘤的诊断经验。方法　分析 19例恶性胸膜间皮瘤的临床资料 ,包括石棉接触史、临床表现、影像学检查、特殊检查、胸水检测和转移情况 ,并对比 15例手术结果。结果　 7例工种与石棉有关 ,占恶性胸膜间皮瘤 36 8% (7/ 19) ,18例 (94 7% )有胸痛 ,其中 16例 (84 2 % )伴胸腔积液 ,1例出现Horner’s综合症并影响臂丛神经。 3例 (15 8% )CT下穿刺找到间皮瘤细胞 ,2例 (10 8% )胸水中找到间皮瘤细胞 ,1例锁骨上淋巴结穿刺找到间皮瘤细胞。 15例CT发现胸膜增厚或胸膜上结节样病灶 ,占恶性弥漫性胸膜间皮瘤 78 9%。 15例手术病例中 11例胸膜广泛增厚或胸壁上广泛不规则大小不等结节融合成片 ,侵犯肺组织或纵隔胸膜、横膈胸膜。结论　石棉接触史是恶性胸间皮瘤主要病因 ,胸痛、胸腔积液是胸膜间瘤的主要临床表现。CT对诊断胸膜间皮瘤有重要参考价值。CT下活检能提高诊断率。更多还原

【Abstract】 Objective To summarize the experience in the diagnosis of malignant pleural mesothelioma.Methods The clinical data of 19 patients with malignant pleural mesothelioma was analysed,including history of exposure to asbestos,clinical manifestations,imaging and laboratory examinations,metastases as well as contrasting the result of 15 operated patients.Results 7 of 19 patients(36 8%)had history of exposure to asbestos.18 cases(94 7%)had obvious chest pain,among them 16 cases had pleural effusion,one case showed Horner’syndrome with brachial plexus nerve involved.These cases malignant mesothelial cells were detected three cases by puncture under CT,two cases in the pleural effusion and one case in the puncture of supraclavicular lymph nodes.Pleural thickening or nodules were found in 15 cases on CT examination. In 11 out of 15 operative patients, wide spread pleural thickening or many irregular nodule fusions were found and lung or mediastinal and diaphragmatic pleura were invaded.Conclusion Exposure to asbestos is the main cause of malignant pleural mesothelioma.Chest pain is always associated with malignant pleural mesothelioma.CT is of good help in the diagnosis of pleural mesothelioma.Puncture under CT can raise the correct diagnosis rate.$$$$更多还原