A Clinical Study Of Peritoneal Malignant Mesothelioma Diagnosed By Laparascopy (12 Cases Report)

Objection: To diagnose peritoneal malignant mesothelioma(PMM) earlier, studying the characters of PMM on laparascopy and differential diagnosis with metastatic cancer tuberculous peritonitis. Methods: Review the clinical data of PMM diagnosed by laparascopic explore and biopsy from 1999 to 2004, summarizing the clinical features , cancer markers , ascites examination and characters on laparascopy. Results: In 12 cases with ascites, 10 cases(83.3%) were yellow and turbid, 2 cases (16.7%) were hematic and 4 cases(33.3%) were viscous; all 12 cases express positive in Rivalta test; 11 cases were found <1 lmg/L in the examination of serum -ascites albumin grads(SAAG); 10 cases were found ascites mesothelial cell obviously higher than 5%, range from 15~60%. On laparascopy, 8 cases were found ascites volume , 1000ml,4cases >600ml; 10 cases(83.3%) were yellow and turbid in appearance, 2 cases (16.7%) were hematic and 4 cases(33.3%) were viscous ; 12 cases were found white small nodules in the abdomen, most of them distributed on lateral abdominal wall(12 cases), epiploon(l 1 cases) and other sites(6 cases of mesentery , 3 cases of ligamentum teres hepatis, 2 cases of intestinal canal wall, 1 case of ovary surface), the diameters of nodules range from 0.3~0.5cm, 2 cases were found nodules > 1.0cm. 3(25%) cases were found epiploon incrassation, one case of them contracted and was nodule-like on surface. 4 cases were found conglutination in the abdomen(2 cases of epiploon with lateral abdominal walk 1 case of colon with lateral abdominal walk 1 case of ileum with lateral abdominal wall) Conclusion: 1. The examinations of content of mesothelial cell in ascites, ascites ADA, ascites cancer markers could differential diagnosis PMM with metastatic cancer , tuberculous peritonitis before laparascopic explore. 2. PMM has the following characters on laparascopy: (1)viscous ascites; (2)white nodules diffusedly distribute in the abdomen with different diameters ;(3)most of the nodules distribute on lateral abdominal wall and epiploon; (4) less conglutination in the abdomen; (5)epiploon and mesentery contracting in later period of PMM. 3. Laparascopic explore is the best method diagnosing PMM...