Chest film Mesothelioma

Chest film Mesothelioma after hasing already prepare a better positive fiber the Mesothelioma with fill the air a malignant chest film a Mesothelioma, the latter's ising think is a chest to prepare behind the worst tumor, up to now still have no valid treatment measure.
The cause of disease learn:
All asbestos fibers of categories, almost relate to the outbreak mechanism of Mesothelioma, but the risk of self-sufficient fiber not same, the most dangerous is to get in touch with a green asbestos, risk minimum of is to get in touch with yellow asbestos.Get in touch with asbestos for the first time with the result that the incubation period of outbreak is generally 20~40 years, the time and serious degree of the outbreak rate and contact asbestos of Mesothelioma become direct proportion.
In the atmosphere such as the hair Fei stone content increment, people inhale the powder of this kind of Huo sour Fei stone, can also cause a Mesothelioma.After having a report way contact emanation line also cause a chest film the case of the Mesothelioma, project from the contact the line to detection suffers from a chest film a Mesothelioma of time is 7~36 years, average 16 years.Second nitric An, glass fiber, hydrogen cyanic acid, oxidize Tu, Pi and the other lung department disease(like the tubercle and the chemistry material and the fat inhalation pneumonia), all can cause a chest film a Mesothelioma.
Pathologic change:
At the malignant Mesothelioma earlier period, can see without the aid of instruments at normal or opaque of there are numerous white or gray grains on dirty layer or wall layer chest film and knot stanza or lamella piece, along with the development of tumor, the chest film surface becomes more and more thick, full with knot stanza, tumor knot stanza to everywhere stretch to postpone, become a slice in a row, wrap bag lung to make its cellar more Suo is more small and make to implicate side chest wall to fall to sink.At the later period, the tumor can involve in a Ge muscle, rib the muscle, Zong separate structure, heart to wrap and to side chest film.The corpse check patient has 50% to discover that the blood relation transfer, but clinical seldom mention.
The malignant Mesothelioma has two kinds of pathologies to dissect a type:① Single the fiber chest film Mesothelioma.The chest film growth, flat panel or meat caulis from the dirty layer form, the tumor causes clinical symptom is because of their extension development, squeeze structure inside the chest to make it move, if can diagnose in early days, can make a surgical operation treatment.The Mesothelioma that the ② extensively spreads.This kind of type infringes upon lobe of lung, gradually Ge muscle, rib muscle, can through a Zong separate a chest film but involve in heart to wrap with greatly afferent.
The microscope of malignant Mesothelioma see it special features, the tumor knot that is in the tumor knot stanza or naked eye external appearance homology of single stanza, all have various obviously different organization composition.Malignant Zhang skin the pathologic organization credit type of the lump was 3 kinds up skin type, fiber( quality) type and mixture type.Last skin type the last skin of the tumor cell contain various different structure, for example nipple form, take care of a form, take care of a nipple form and take a form achievement a slice a form.The skin cell has on the polygon a lot of long but slender, the surface contains the tiny floss of branch, bridge grain, become the elasticity thin silk and cell of bunch a chamber.Fiber type the spindle form with similar cell, the equal Gou form, there is the cell nucleus of egg form or thin long form and check Ren growth good.Mixture type and is two kinds of organization structure up skin type and fiber type.While taking to live check from a tumor piece, the specimen taken from the each one different part is many more and then seem a mixture type more.
Malignant chest film Mesothelioma the patient be male much in female.(2 ∶s 1)Most patients at 40~70 years old of, foreign patient the average ge be 60 years old and our country is 45.2 years old.The head hair symptom is a chest pain, a cough compatibly short and the most familiar, about 10.2% patients with have fever and perspire, 3.2% patients regard joint pain as principle tell symptom.Because the Ge muscle implicate and, the chest pain can conduct highest belly and suffer from a side shoulder a department.BE about 50% patients with 60% ～s to have a great deal of chest water companion to seriously annoy short, among them, guts chest water have 3/4.Have no the patient's chest of a great deal of chest water painful more violent.The weight ease familiar.Some patients appear the periodic low blood sugar a disease with fatty and big sex lung bone joint, but these advertise for more see at the positive Mesothelioma.
Last skin type and mixture type chest film Mesothelioma often the companion contain a great deal of chest water, but the fiber type usually only have a little amount or have no chest water.Last skin type the patient seem to be more involve in the top of the lock bone or armpit lymphoid knot and stretch to postpone to the heart to wrap, to the side chest film and peritoneum;The fiber type has distance more to transfer to transfer with bone.
The emanation learns to advertise for:The familiar X line chest slice discovers a chest film the chamber accumulates a liquid and often have 50% of one side chest.Together the side lung is organize by the tumor to wrap up, the Zong separates to move to have the tumor one side, suffer from side chest to diminish a condition a chest slice for later period don't the Zong separate to increase breadth and the heart wraps a Shen liquid to make the heart shadow extend, it is thus clear that soft organization shadow and rib break.
At the X line normal regulations chest slice top chest the disease of the film can be accumulated a liquid by the chest to cover up, to the patient who evaluates to doubt a malignant chest film quality lump, the CT check the most useful, the CT can show the chest film increases thick companion irregular knot stanza good luck inside the form and recognize a malignant chest film a Mesothelioma from other chest films increase a thick pathological changes with this.In order to thering are fiber organization and tumor organize with chest water, main the lung's crack obviously increases thick, such as is tumor infringe upon, the lung crack can express for knot a stanza form.Usually the CT can discover knot stanza inside the lung and lung to be wrapped degree and chest wall that the bag contract by the tumor to fall the circumstance for sink.
Have the exudation chest water, specially have contact asbestos the patients of the history all should consider a malignant chest film quality skin the diagnosis of the lump.The chest CT can make sure diagnosis and chest CT check's can judge the chest film calcify or bone structure has already denied breakage.When the tumor infringes upon Ge muscle and chest wall, develop of Ci resonance compare CT is good.(figure 1)Although chest water cell Tu2 Pian4, chest wear a chest film to live check and chest water cell piece slice and can make a diagnosis of ill nature, can't discriminate a chest film to transfer sex gland cancer and malignant skin 廇 .
Ci resonance:Right descend chest wall a malignant chest film a Mesothelioma
Left descend lung to descend leaf carry a dirty layer on leaf's back also have a malignant chest film a Mesothelioma(the surgical operation confirm)
If in the past 10 years in developped 3 kinds of techniques, Be more and affirmatively contribute to making to visit patients at home to break to the malignant Mesothelioma.This 3 kinds of techniques are with Gao Dian3 Suan-the rare man liquid do organization chemistry dyeing and make immunity by the Cape Ruan and the cancer Pei antigen to check over examination and electronic microscope of the oxide Mao.In order to carry on these checks, live the check specimen has to immediately use neutral blessing joy Ma3 Lin2 Yi4 fix, the another bit of tumor lives check specimen to destine to be provided to make electricity mirror check to use in E two Quan liquids.
Gao Dian3 Suan-rare the man dyeing(PAS) is an only one dependable organization chemistry method, it can recognize malignant chest film Mesothelioma and gland cancer, although various characteristic which transfer a sex gland cancer not same, appear a strong and male empty bubble after the starch Mao digest, then diagnosis is gland cancer rather than malignant chest film Mesothelioma.
Immunity's leading an oxide Mao's technique is to use an antibody function antigen(CEA) at the Cape Ruan egg white and cancer Pei, this method also availably distinct malignant chest film Mesothelioma in transfer a sex gland cancer.Make immunity to lead oxide Mao to dye to the cancer Pei antigen, malignant chest film the dyeing of the Mesothelioma's being generally very thin don't apply color.Contrary, the gland cancer dye medium etc. with very thick.In addition, the in order to prevent epidemic disease leads the oxide Mao opposite angles Ruan to make a research and also show that Mesothelioma and gland cancer contain obvious difference.Have already discovered that 8 markings can make to discriminate to use currently:The tumor merge sugar egg white 72(B72.3), Leu-Mi, Vimentin, the blood bolts to adjust to cure a vegetable, glue egg white composition and the cancer antigen masculine gender has 100% special and sensitivity to the gland cancer.Because cancer Pei antigen the examination often has false feminine gender, so had better choose to use two tumor markings, general usage CEA and B72.3.Have 100% special to the gland cancer such as their masculine gender with 88% sensitivities;If both all feminine gender, have 100% special to the Mesothelioma with 97% sensitivities.
Electronic microscope check to recognize malignant chest film Mesothelioma and chest film to transfer a sex gland cancer an useful way also.Malignant chest film Mesothelioma's discriminating between the gland cancer of lung, mammary glands cancer and the top stomach and intestines way source is the tiny floss of its surface thin and long, and have branch, the tension silk is more abundant and have no small root and slice of tiny floss to pack a body;Come from the transfer of film sex gland cancer inside ovary and womb has inside organization to transform, include to abundantly glue the egg white small drop, a great deal of cilia, intensive pit grain, these varieties are nonexistent at the quality lump, and the floss of gland cancer is short and thick.
Malignant chest film's pathologic diagnosis problem of the Mesothelioma still includes an issue.Although the malignant Mesothelioma together categorizes with soft organization tumor,only 20% histology tops be pure tumors.Malignant chest film 33% ～s of the Mesothelioma 50% the top of its histology is last skin type or tube form and nipple form, but other 30%s is last skin and tumor mixture type, most pathology house make sure only have tumor or mixture organization of patient, then can diagnose to do evil a sex chest film a Mesothelioma.Comprehensive special dyeing and electronic microscope check data, experienced pathology house would like to also to top skin type of patient, make a malignant chest film the diagnosis of the Mesothelioma.
Until today, to malignant chest film Mesothelioma still the man valid treatment method, but through a certain method treatment all had a handful of patients to once live at home and abroad for 5 years, most the elder reach to for 22 years and the most people thinks and may have something to do with tumor nature existing time and cent to expect.Expect by the Butchart cent, the malignant chest film Mesothelioma is divided into four periods.(table 1)
According to the clinical performance, the Ⅰ expects a skin type a malignant chest film the Mesothelioma probably exists over a long period of time, past the suggestion makes to cure for good the sex chest film lung resection for these patients.To the Ⅱ , Ⅲ and the Ⅳ expect ascend the case of skin type and other pathologic types, regardless cure with incurable, whether adoption cures for good sex or appeasement surgical operation and uses a chemotherapy and puts to treat curative effect or not, treatment empress of existence the curve be basic homology, it equally exists time as 18 months and about 10% cases once lived for 3 years.
Form 1 malignant chest film Mesothelioma of the clinical cent expect
The Ⅰ period tumor limits at a wall layer chest film and involves in to wrap with side chest film, lung, heart to separate with ZongThe Ⅱ expects the tumor invasion chest wall or involves in Zong to separate structure, namely oesophagus, heart and to side chest film.The lymphoid knot implicates in the chest(N2)The Ⅲ period tumor cuts through a Ge muscle to involve in peritoneum and the invasion involves in chest to outside pour to fawn on to the side chest film and double side chestThe Ⅳ expects blood relation bone in the distance to transfer
1.Appease sex treatment malignant chest film Mesothelioma patient's chest water, wear to stab to suck out very quick behind again appear, use a chemistry medicine infusion a chest film inside chamber, result in the chest film glue connect, chest water of most patients gets a control, so the chest film fixed Shu if failure or is draw up to go diagnosis to open a pectoral patient, should consider that doing a chest film shells to take off Shu.
The malignant chest film Mesothelioma can follow to wear to stab bore and place the passage of chest tube and open chest to slice to sow to spread, but the skin cause descend the deposition thing seldom causes symptom, so need not cure, if give patient treatment, these the skin descend knot stanza can also be observe curative effect of index sign.
Malignant chest film the Mesothelioma patient's chest pain is the symptom of the most difficult processing, specially serious all day long keep keep on in the later period, treat and respond towards putting, should give enough town quiet analgesic, include an opium product to soothe ache, Anne Du life of last moment.
2.Surgery's cure has already had the chest film Mesothelioma surgery of malignant various treatment the measure currently, is to extend the sex chest film lung resection first, then cure for good the parts of chest walls, whole lungses, Ge muscle, Zong that sex excision is involve in to separate to wrap with heart.This Shu type is applicable to a malignant chest film Mesothelioma case of the Ⅰ period function top skin type.The serious heart lung function damage is the taboo certificate of this Shu.At 4 rib do one standard of empress outside the side open chest to slice, tough and resilient but increase thick wall layer chest film and tumor to knot stanza together, the bluntness is from the chest wall removal, this operation will cause extensive issue of blood, can oppress, give or get an electric shock to burn and sew firm cautiously and thoroughly stop bleeding.Then, separate Zong the chest film separates from the coping of lung door, cut off windpipe side lymphoid knot.Fore noodles, in the lung sharp level, the ligation artery inside the milk and vein, formerly chest wall excision and these blood vessel and chest film together of havings it is thus clear that lymphoid knot.At the behind, cut off the oesophagus compatibly takes care of the lymphoid knot of the area of Long Tu beside.Behind correspond part to cut open heart to wrap from the left side.Want to decide to slice lung first or cut off a Ge muscle first at this time, this is in proper order to be decided by the part of the tumor invasion and the scope of its extension.The crossing lung door and blood vessel and bronchus, treatment is like whole lung to cut off in any heart the pack(extension) similar.The chest film lower part is unlike the Ge muscle so low, can outside cut off a Ge muscle in the chest film lower part wrinkly plait after visitting to leave a chest film.For the full revelation, generally want at together side 8~10 make the 2nd slice.Because in the Shu place a patient after side lying, at cutting off a Ge muscle, the liver inclines toward to separate to move toward the Zong from the top and oppress chamber vein, cause heart palpitates and blood obstacle.After cutting off a Ge muscle, its defection and damage can use Maxlex net or the material repair of the Di Lun Huo quality and also someone use a hard ridge film a repair.Regardless adopt any material and technique, have to attain tight and gastight, in order to prevent stop bleeding liquid or chest water from the chest farmers' association inflow belly cavity;Shoulding use to sew up a method in a row, being firm the substitute of Ge muscle to sew up the cripple remaining edge of Ge, making stomach internal organs a machine can't the Tu go into or the Shan go into inside chest.Close should link a chest tube before the chest negative press attraction at the attraction machine.The surgical operation death rate which extends the sex chest film lung resection's ising 10% ～s is 25%s, but curative effect unlike chest film resection good, past don't suggest extensively applied.
The second surgery treatment measure is a chest film resection, this Shu doesn't cure for good sex and often involve in it because of the tumor nether of lung.This surgical operation also can't improve a malignant chest film a Mesothelioma a patient of existence time, but can apparently control chest water, the improvement patient's living quality.In addition, malignant chest film the chest pain cause by Mesothelioma, sometimes can alleviate after cut off chest film to doubting the case which does evil a sex quiet film Mesothelioma, draw up to make diagnosis to open chest to live check, should consider doing a chest film resection in the meantime.There is a great deal of chest water, and the chemistry chest film fixed Shu fail of case, can also consider doing a chest film resection.From top say, the chest film resection appeases sex surgical operation and its purpose cuts off a wall layer chest film and part of dirty layer a chest film to prevent chest water from relapse and ease the chest painful symptom.The outside side slices to open chest, bluntness or Rui to swim to leave after generally curing 6 to make wall layer and part are involve in by the tumor of dirty layer chest film, take off after separating from the chest wall and the lung respectively in addition to, this operation will cause to make spinal cord or arm nerve cluster damaged because of the hot conduction, had better use high Pin argon gas knife when the spinal column side and chest crest cut off tumor.Specially want to carefully keep nerve and blood vessel that chest coping and Zong separate area, cut off tumor organization possibly, reduce its capacity, put to treat with chemotherapy after being advantageous to Shu.The Shu fully places the chest shut type to lead to flow negative press attraction.
3.The Mao wreath medicine of the chemistry treatment is think the Mesothelioma is to the malignant chest film valid, is a secondly agreeable platinum, silk crack mildewed vegetable, wreath Lin Mao An, fluorine urine Mi Ding, AN ammonia Die purine, long spring flower alkali Mao An etc., much adopt currently, the Mao wreath is main of comprehensive chemotherapy.Statistics at home and abroad in recent years with mildewed vegetable is main chemotherapy project, total efficient is or so for 20%, among them better is new alkali(CAO);Don't contain various treatment project of the Mao wreath total efficient is 21%, among them better is a silk crack mildewed the vegetable add agreeable platinum(MP).Agreeable platinum enlargement quantity AN ammonia Die purine.The chemotherapy keep on the condition doesn't turn worse.
4.Project a treatment exterior to put to treat a Mesothelioma to be disappointed, but extend sex body to outside put to treat to be thought effectively to the malignant chest film, can alleviate the chest of some cases pain and control chest liquid, but to the disease disease is without the curative effect.The body outside projects light upon a 40 Gies to above have the appeasement the curative effect, the 50~55 Gy irradiation alleviates the rate as 67%, a handful of patients exist for 5 years with, but almost all patients still die in to relapse or transfer.
Put to treat to have some reactions to a handful of malignant chest film Mesotheliomas inside chamber, and the long-term curative effect of a handful of patients, see to have a glimmer of hope.Mainly using isotope is mainlya radio gold, it matches sex with overlay cell of strach the film chamber to have in person, specially suited for a treatment to fill the air sex tumor, for example Mesothelioma.It mainly cures effect because of the radio ofβ quality grain, is it of wear deeply dint to reach to a 2~3 mms, most valid to the tumor in earlier period, but very difficult detection in early days malignant chest film the case of the Mesothelioma.The early years applies inside the gum body 198 golds infusion chest film chamber, have already lived a handful of cases for 5 years, because of protection difficulty, currently already few applied.
Comprehensive treatment and the irradiation or the isotope 132 Is, 192 Irs, 32 Ps in the surgical operation transplants a chamber and the body outside puts to treat to add a chemotherapy after the Shu etc. measure, all have no forward to cure.
5.Comprehensive treatment in recent years, adopt comprehensive treatment measure, after the chest film lung cut off believe and CAP project chemotherapy.(the wreath Lin Mao An 600 mgs/m 2, the mildewed plain 60 mgs/m 2, , agreeable the platinum 75600 mgs/m 2, treat a distance with 5 in a row, treat distance partition for time for 3 weeks each time)After the Shu at originally the part of the tumor or the position of the cripple remaining tumor make the body outside with 55 Gies to project light upon.Analyze 53 the example accept a comprehensive treatment of patient, round the surgical operation period complications incidence rate 17%, the surgical operation death rate is 5.8%.Average existence time be 16 months(1~8 years).The patient's 1, 2 and 3 years existence rate of 31 top skin type distinguishes to 7%, 50% and 2%;The 1 and 2 years Shu young man of mixture type and tumor type patient saves the rate as 45% and 7.5% and the none example once lived for 25 months.The partial Zong separate lymphoid knot assignor existence time more have no lymphoid knot the assignor be short, top skin type the Zong separate lymphoid knot feminine gender, it 5 year, existence rate is 45%, so carry on treatment in early days very important.