Diffuse malignant mesothelioma

"Treatment"



Until today, for malignant pleural mesothelioma Shangfu effective treatment, but after treatment in one way or another, have a small number of patients live at home and abroad over 5 years, up to 22 years, most people think may be related to natural tumor survival And the stage. Butchart by stages, malignant pleural mesothelioma is divided into four phases (Table 1).



According to the clinical manifestations, ⅰ period E-malignant pleural mesothelioma may have long-term survival, it is suggested that these patients for radical resection of lung pleura. On ⅱ, ⅲ ⅳ period and the E-pathology and other types of cases, both dead and the government to adopt radical or palliative operation and the use of chemotherapy and radiotherapy effect or not, after treatment the survival curve is basically the same, the average survival time of 18 months, about 10% of the cases have been living for 3 years.



Table 1 malignant pleural mesothelioma clinical stage of tumor confined to the period ⅰ parietal pleura, the only side involved pleura, lung, pericardium and mediastinal tumor invasion period ⅱ chest wall or mediastinal structures involved, that is, esophagus, heart and the opposite pleura. Only in the chest lymph node involvement (n2) ⅲ period of peritoneal tumor through the diaphragm involved, violations of the opposite pleura and chest bilateral, involving the lymph nodes in the chest outside ⅳ period of blood-borne distant bone metastases



1. Palliative treatment of malignant pleural mesothelioma patients, needle aspiration will occur very soon after, with chemical agents into the pleural cavity, resulting in pleural adhesions, the majority of patients with pleural effusion under control, so pleurodesis If it fails or To be in line diagnosis of the patient's chest, should consider doing pleural endarterectomy.



Malignant pleural mesothelioma can puncture holes along, the home of the chest and thoracic incision channel disseminated, but the skin caused by sediment rarely cause symptoms and therefore do not have treatment, if given the treatment of patients, which can also serve as subcutaneous nodules Observation of the efficacy of indicators.



Malignant pleural mesothelioma patients with chest pain is the most difficult to deal with the symptoms, particularly in the late, sustained non-stop all day, without radiation reaction, should be given enough sedative analgesics, including opiates agents in order to alleviate pain, a peaceful transition to life in the last moment .



2. There are a variety of surgical treatment of malignant pleural mesothelioma surgery, is the first expansion of pleural pneumonectomy, that is radical resection of the involved were part of the chest wall, the whole lung, diaphragm, mediastinal and pericardial. This procedure applies only to ⅰ period features E-malignant pleural mesothelioma cases. Serious heart and lung damage is contraindication of this technique. 4 intercostal do a standard posterolateral thoracotomy incision will be tough and pleural thickening of the wall and the tumor nodules together, blunt dissection from the chest wall, this will cause extensive bleeding, oppression, and electrocautery Carefully suturing completely stop bleeding. Then, mediastinal pleura from the top of the hilar separated from the trachea removal of lymph nodes. In front of the apex in the level of internal mammary artery ligation and vein, the former chest wall and the removal of these blood vessels and pleura can be seen all along the lymph nodes. In the back, the removal protuberans trachea and esophagus next to the area lymph nodes. From behind the left side of the corresponding part of the pericardial incision. At this point decided to cut lung resection or first diaphragm, which depends on the order of the tumor site and its extension. Cross-sectional and hilar vascular and bronchial and treatment as any in the pericardial (of expansion) as pneumonectomy. Unlike the lower part of the pleura diaphragm low as can be free in the pleura, the outer fold in the lower part of the pleura diaphragm removed. In order to fully exposed, there are generally the same side in the 8 to 10 for the 2nd intercostal incision. As a result of surgery patients in the home side, the removal of the diaphragm, the liver tends to shift to the mediastinum, the oppression of the inferior vena cava, resulting in heart rate and blood flow obstacles. After the removal of the diaphragm, the defect can be used maxlex network Dilun or silica material to repair, it was used to repair spinal. No matter which materials and technology, must not be missed tight to prevent the effusion of blood or chest by the farmers would flow into the abdominal cavity; should be used for suture, the diaphragm will be a substitute for a strong suture remnants of the edge of the diaphragm, so that intra-abdominal organs can not be Into the hernia or into the chest cavity. Guan chest chest tube should be connected to the suction device to attract. To expand pleura of the lung resection surgery mortality rate of 10% to 25%, but the effect is no less than pleural resection, and therefore does not recommend wider use.



The second measure surgeon for the treatment of pleural resection, non-radical surgery, the tumor often tired following their lungs. This surgery does not improve patients with malignant pleural mesothelioma survival, but seems to be able to control the pleural effusion, to improve the patient's quality of life. In addition, the malignant pleural mesothelioma caused by chest pain, and sometimes in remission after removal of the pleura, the membrane static suspected malignant mesothelioma cases, intended for the diagnosis of thoracic biopsy should be considered at the same time do pleural resection. There are a large number of pleural effusion, and chemical pleurodesis failure of the case, it may consider doing pleural resection. From the above, the pleural resection is a palliative operation, with the aim of parietal pleura and the removal of some of the visceral pleura, to prevent the recurrence of pleural effusion and reduce the symptoms of chest pain. General rule for the 6th intercostal posterolateral thoracotomy incision, blunt or sharp-free by wall and part of the tumor involvement of the visceral pleura, respectively, from the chest wall and lungs removed after the separation, this will cause a result of heat caused by spinal cord or arm Plexus damage to the spine in the peri-top chest to remove the tumor, it is best to use high-frequency argon knife. In particular to be careful to keep at the top of the chest and mediastinum area of nerves and blood vessels, as far as possible to remove the tumor, to reduce its volume, in favor of postoperative radiotherapy and chemotherapy. Chi Bi surgery closed thoracic drainage suction.



3. Anthracycline chemotherapy agents are considered effective for malignant pleural mesothelioma, followed by cisplatin, mitomycin C, cyclophosphamide, fluorouracil, methotrexate, Vindesine, and so on, the current use of , Anthracycline-based chemotherapy integrated. In recent years, the statistics at home and abroad in order to adriamycin-based chemotherapy, with a total effective rate was 20%, of which Afghanistan is good new alkali (cao); non-anthracycline treatment of a variety of general efficiency 21% of which is better mitomycin plus cisplatin (mp). Cisplatin increase the dose methotrexate. Chemotherapy continued until did not aggravate the disease so far.
4. Radiotherapy external radiation therapy for malignant pleural mesothelioma is very disappointing, but the expansion of external radiation therapy is considered effective, can alleviate some of the cases of chest pain and control of pleural effusion, but the disease itself has no ill effects. 40gy in vitro exposure to more than palliative effect, 50 ~ 55gy irradiation remission rate of 67%, a small number of patients survive 5 years, but almost all patients still die of recurrence or metastasis.



Brachytherapy on a small number of malignant pleural mesothelioma have a reaction, and a small number of patients with long-term effect, it appears that there is a ray of hope. The main use of radioactive isotope is gold, covered with serous cavity of the cell have affinity, particularly suitable for the treatment of diffuse tumors, such as mesothelioma. The main effect of treatment as a result of the radioactive β plasmid, and its ability to penetrate up to 2 ~ 3mm, for the most effective cancer early, it is difficult to find early cases of malignant pleural mesothelioma. Application of colloidal gold 198 years ago into the pleural cavity, there is live over 5 years a small number of cases because of difficulties in protection, at present there are only a few applications.



Comprehensive treatment and surgery or radiation isotope 132i, 192ir, 32p and the cavity after implantation of radiation plus chemotherapy in vitro, and other measures are no long-term cure.



5. Comprehensive treatment in recent years, integrated treatment measures in the pleural pneumonectomy letter cap and chemotherapy (cyclophosphamide 600mg/m2, Adriamycin 60mg/m2,, cisplatin 75600mg/m2, continuous treatment with 5 Each course of treatment interval of 3 weeks). After the original tumor site or location of the residual tumor 55gy for in vitro irradiation. Analysis of 53 cases of patients to receive treatment, the perioperative complication rate of 17%, 5.8% operative mortality. The average survival time of 16 months (1 to 8). 31 cases of patients with E-1, 2, 3-year survival rate was 7%, 50% and 2%; and mixed-sarcoma patients 1, 2-year survival rate after 4.5% and 7.5%, none of living Over 25 months. Local mediastinal lymph node metastasis survival time than those without lymph node short, E-lymph node-negative, the 5-year survival rate was 45%, so early treatment is important.



"Etiology"



All types of asbestos fibers, and almost all of the pathogenesis of mesothelioma, but the danger of fiber self-sufficiency is not the same, is the most dangerous Qingshi contact with asbestos, the danger is minimal contact with asbestos Huang. First contact with asbestos-induced disease incubation period is generally between 20 to 40 years, the incidence of mesothelioma and asbestos exposure time and in direct proportion to the seriousness of.



In the atmosphere, such as hair zeolite content, such people inhalation of silica zeolite powder, which can cause mesothelioma. Has also been reported after radiation exposure caused by pleural mesothelioma cases from radiation exposure was found to suffer from pleural mesothelioma time for 7 to 36 years, an average of 16 years. Nitrosamines, glass fiber, hydrocyanic acid, thorium oxide, beryllium and other lung diseases (such as tuberculosis and chemical substances and lipid aspiration pneumonia), can lead to pleural mesothelioma.