恶性胸膜间皮瘤的外科治疗.doc

恶性胸膜间皮瘤--外科治疗的角色（综述） 卢喜科 天津市胸科医院(300051) 胸外科 Malignant Pleural Mesothelioma: The Role of Surgery LU Xi-ke Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, 300051, P.R.China 【摘要】 目的：通过复习国内外文献探讨恶性胸膜间皮瘤的治疗选择并评估外科治疗的角色。方法：通过Medline和Pubmed输入关键词恶性胸膜间皮瘤，胸膜切除术/胸膜剥脱术，胸膜外肺切除术。自1990年1月1日至2009年6月1日共搜出2699篇相关文献，排除重复或类似文献，最终选取具有代表性文献40篇。并总结分析按循证医学的理论列出证据水平和建议等级。结果：性胸膜间皮瘤单纯的放化疗或是单纯外科治疗均不能达到满意疗效，早期病例以手术为主的综合治疗能够带来有益处的生存。治疗MPM病人对于那些上皮型、局限型、纵隔淋巴结阴性者仍首选 EPP治疗并综合治疗，对不能忍受EPP手术的病人并能进行R0或R1切除的病人，应行P/D以手术并术中纵隔淋巴结切除术为主的综合治疗（证据水平2b，建议等级B）。姑息性（R1））P/D手术在治疗MPM中具有有限的作用。结论：外科手术在治疗恶性胸膜间皮瘤中扮演重要角色。 【关键词】恶性胸膜间皮瘤；外科治疗；总数文献 [ABSTRACT] OBJECTIVE: To review international literature and study the treatment of malignant pleural mesothelioma (MPM) and evaluate the role of surgery in treament of MPM. METHODS: To obtain information regarding MPM, a Medline and PubMed search was performed of reports published in Englishi between January 1, 1990 and June 1, 2009 using the search term “malignant pleural mesothelioma” and “pleurectomy/decortication” and “pneumonectomy”. The search yield 2699 abstracts, depleting repeated or similar literature and selecting represtntative literature. The number of literature quoted was 40. According to Evidence Based Medicine the levels of evidence and recommendation grade was outlined. RESULTS: Chemotherapy and radiation and surgery as a single-modality therapy has not been overly successful in the treatment of MPM. Surgery combined multimodality therapy as mainstay treatment in patients with early state disease. The patient with epithelial histology, limited bulk disease, and who are mediastinal node negative will benefit from EPP and combined chemotherapy and radiation. P/D with mediastinal node resection was performed in patients who cannot tolerate EPP and in whom an R0 or R1 resection can be delivered (level of evidence 2b; recommendation grade B). Palliative (R1) P/D has a limited role in the management of MPM. CONCLUSION: Surgery was one of the important r