石綿相關肺疾病病例報告與文獻探討－肋膜斑與惡性間皮瘤

Asbestos-related Pleural Plaques and Malignant Mesothelioma: Two Case Reports and Literature Review

10.3966/168232812015062502006

黃勇誠(Yung-Cheng Huang)；林瑜茵(Yu-Yin Lin)；陳怡庭(Yi-Ting Chen)；王肇齡(Chao-Ling Wang)；莊弘毅(Hung-Yi Chuang)

石綿 ； 肋膜斑 ； 惡性間皮瘤 ； 職業暴露 ； asbestos ； mesothelioma ； pleural plague ； occupational exposure

台灣家庭醫學雜誌

25卷2期（2015 / 06 / 01）

157 - 164

繁體中文

石綿引起的肺疾病主要包括惡性間皮瘤、石綿肺症、肺癌、肋膜斑，及瀰漫性胸膜增厚等。本文報告兩位有石綿職業暴露史，分別罹患惡性間皮瘤與肋膜斑的病例。惡性間皮瘤個案是一位62歲女性，年輕時是拆船業鋼板切割工；肋膜斑個案是一位72歲男性，年輕時從事管路保溫工程，這兩位個案皆已離開石綿暴露環境約30到40年。本文針對石綿暴露、肋膜斑、惡性間皮瘤、肋膜斑與惡性間皮瘤之間的關聯性進行文獻探討；也將國內報導過的石綿暴露相關惡性間皮瘤案例作統計，以提醒國人與醫師應持續注意石綿的危害，雖然法令已經將石綿逐步禁用，但早期石綿暴露對於國人的健康危害依然方興未艾。我們建議：家庭醫師問診時應對於可能有石綿暴露史的在職與離職勞工特別注意，而主管機關應詳細登記作業經歷、建檔管理，並提供定期健康檢查，以早期發現石綿暴露相關病例，並協助勞工申請勞保補償。

Asbestos has been found to induce lung diseases, nobtably malignant mesothelioma, lung cancer, asbestosis, pleural plaques, and diffuse pleural thickening. We reported two cases of asbestos-related lung disease. One had malignant mesothelioma and the other was diagnosed with pleural plaque. The first case was a 62-year-old woman who suffered from chest pain, shortness of breath, and productive cough for 1 week. Chest X-ray revealed considerable right-sided pleural effusion, and pleural biopsy later confirmed the diagnosis of malignant mesothelioma. She had worked as a flame cutter in the shipbreaking industry for 7 years in Kaohsiung since she was 19 years old. The second case was a 72-yearold man reporting no previous chest discomfort. Bilateral pleural plaques were found accidentally when he was admitted to the hospital due to acute pancreatitis. Both chest radiography and computed tomography showed bilateral calcified pleural plaques. He had worked in pipe insulation business for 40 years since he was 24. The two cases have no longer in direct occupational exposure to asbestos for approximately 30-40 years. We performed literature review on pleural plaque, malignant mesothelioma, and the relationship between the two diseases. In spite of the fact that asbestos has been progressively banned, family physicians should continue paying attention to inquiring into previous hisotry about occupational exposure to asbestos because previous exposure to asbestos, even a distant one, may still raise the risk of asbestos-related diseases due to its long latent period. Family physicians are therefore advised to make inquiry into a patient's work experience and occupational exposure to asbestos as an essential part of their assessment and diagnosis. In addition, competent authorities should take the initiative to help patients with asbestos-induced diseases apply for workers' compensation.

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