Peritoneal mesothelioma (peritoneal mesothelioma) in the primary peritoneal mesothelial epithelium and the tumor, clinical rarely see. Pathology can be categorized as adenomatous mesothelioma (adenomatoid mesothelioma), cystic mesothelioma (cystic mesothelioma), and malignant mesothelioma (peritone al malignant mesothelioma, PMM). The first two are benign. Cystic Mesothelioma more common in women, cause unknown, occurs in the pelvic or around the annex, was single or multiple cystic masses; Patients often palpable abdominal mass and treatment. SILVER malignant mesothelioma about 30%; Its incidence is also closely linked with exposure to asbestos. About 5% of patients with history of exposure [1]; Asbestos fibers oral intake, translocation through the intestinal wall into the peritoneal and pathogenicity. From exposure to asbestos that were diagnosed, the disease incubation period could be as long as 25 ~ 40 years. But domestic 1951 ~ 1993 20 literature analyzing 161 cases only one cases with asbestos exposure history. In the absence of a history of exposure to asbestos population, the incidence rate of about 1 / 1 million a year, may be some infection and genetic factors [2,3,4]. Abroad have reported a case of analyzing patients 40 years ago, I contacted glial thorium dioxide (Thorotrast) [ 5]. SILVER often occurred in men over the age of 40. Visceral or parietal peritoneum and may happen; Tumors can be a direct violation of abdominal, pelvic organ; 50% ~ 70% of patients with lymphatic and (or) hematogenous metastasis distant as liver, kidney, adrenal gland, lung, bone and lymph node, and so on. Clinical manifestations of this lack of specificity, and may have abdominal pain, constipation, swelling, weight loss and other obstruction performance [6]. Physical examination can be found ascites or abdominal mass. Ascites exudate part of gutsy. The disease often misdiagnosed as tuberculosis peritonitis and recurrent spontaneous bacterial peritonitis, mesenteric inflammation or peritoneal metastasis of cancer, and so on. Ascites hyaluronic acid increased significantly, "0.8 g / L were only found in analyzing. Ascites cytology has a certain value, but often difficult to judge. Serum carbohydrate antigen 125 (CA125) increased help diagnosis of the disease [6,7]. Ultrasound and CT performance varied, the typical person irregularly thickened peritoneum, omentum was Caky adhesions, tissue samples were mesenteric; CT may also show increased Peripancreatic large mass, or intraperitoneal substantive diffuse large mass, and bowel and mesenteric violations; or peritoneal nodules or showed a cystic mass; more with different degree of ascites [8]. Ultrasound or CT-guided biopsy is a definite value. Laparoscopy is analyzing the diagnosis of simple and effective method of endoscopic see peritoneum, omentum and diffuse nodular plaque, may look biopsy pathology examination. We had given one 83-year-old male patient laparoscopy, peritoneal biopsy report mesothelial cell hyperplasia, After immunohistochemical tests confirmed analyzing side. Butchart and others will be divided into four SILVER : I, confined to the peritoneal tumor; Phase II, intraperitoneal tumor invasion lymph nodes; Phase III, to the peritoneal tumor metastasis outside; Ⅳ, distant metastasis. These classifications will help choose the method of treatment. SILVER so far no effective standard treatment programs. The prognosis is poor, survival after diagnosis for a period, the median survival of more than two years of less than 20%. Mainly died for cachexia, or obstruction, and the cause of death rarely distant metastasis of the tumor.


Treatment
Surgical excision of cystic mass effect is very good and without postoperative deaths reported. But 25% of patients with local recurrence. Van der Klooster reports on one cases with multiple cystic mesothelioma patients. by suction and occlusion treatment were ineffective, a tumor recurrence five years times, the last to switch to vaginal intubation continuous drainage, eventually cure. Surgical excision of cystic mass effect is very good and without postoperative deaths reported. But 25% of patients with local recurrence. With laparoscopy can complete resection of giant cystic peritoneal mesothelioma.

Right I, Phase II analyzing the preferred surgical treatment. Operation include the reduction of tumor surgery (cytoreductive surgery), possible removal can see the tumor tissue. But because of the difficulty in surgery, diffuse lesions, the complete resection difficult to achieve the objective. Right recurrence can be re-operation. Ileus is feasible right palliative surgery, obstructive symptoms.
SILVER less sensitive to radiotherapy, radiotherapy result is not as good as pleural mesothelioma. But the surgical resection of the lesions has not been fully or not surgery, radiotherapy is nonetheless an important therapy. Including external irradiation and (or) irradiation. External irradiation generally choose 60 or 186KV Co. as X-ray sources, depending on the scope of diseases to choose partial or whole abdominal irradiation. Medicine tumor patients to the hospital whole abdominal irradiation, six-seven weeks of radiation doses up to 24 gray (Gy). Results of local recurrence rate to 11.4%, three-year survival rate increased to 66.7%. Radiotherapy can cause abdominal radiation, radioactive radiation myelitis and hepatitis. Intraperitoneal injection of radionuclide P as 32 or 198 Au, through radiation and mesothelioma organizations and small vascular sclerosis. and the anti-free ascites tumor cells, a short-term illness mitigation. But this method will need equipment, and the price is very expensive, and can inhibit the bone marrow, has been seldom used.
Drug analyzing moderately sensitive to chemotherapy. Pre-operative chemotherapy, surgery and post-operative adjuvant chemotherapy can significantly reduce tumor recurrence, three years to improve the survival rate.
SILVER certainly result in the treatment of chemical drugs doxorubicin, cisplatin and carboplatin, bleomycin and a new anticancer drug Eiemene other. Vincristine, fluorouracil, cyclophosphamide, mitomycin also worth a try.
Doxorubicin (Adriamycin, ADM) for each adult 30 ~ routinely. Every three weeks one time, intravenous or intraperitoneal injection of a total dose of not more than 550mg/m2. Adverse reaction to a cardiac toxicity, there is accumulation, with the total dose; Followed by bone marrow suppression. gastrointestinal reactions and alopecia.
PDD (cisplatin, DDP, cisplatin) for each adult 80 ~ 120mg/m2, every three times a week; or 20 mg/m2 for 5 days every 3 weeks for a course of treatment, intravenous injection. Adverse reactions are nephrotoxicity and ototoxicity, neurotoxicity, gastrointestinal reactions and bone marrow suppression. Plus mannitol to reduce its accumulated in the tubular cells. The drug is commonly used in the intraperitoneal injection, the specific method described below.Carboplatin (Carboplatin, CBP) Adult 300 ~ 400mg/m2 each. by adding 5% glucose solution or saline, diluting the concentration of the solution 0.5mg/ml, intravenous drip, Each three-four weeks duplication; or 100 mg / d, to 5% glucose solution 500ml intravenous drip for 5 days; 3 ~ 4 times a week to repeat. Can be used for each 300 ~ 500 mg intraperitoneal injection once a week.
Bleomycin (hopefully, the BLM) Adult use 15 ~ 30mg, dissolved in saline or modest 5% glucose solution deep intramuscular, or intravenous injection two times a week; also, under the circumstances, to a time / d or several times a week. Can also be dissolved after 60 mg intraperitoneal injection of slow. Stey with BLM intraperitoneal injection, treatment one cases analyzing patient outcome ascites disappeared, the withdrawal did not arise again. survived for more than three years. But BLM large dose intraperitoneal injection can cause pneumonia-like symptoms, or even pulmonary fibrosis; In addition, fever, gastrointestinal reactions more common. Patients allergic individual.