摘要
目的总结脑膜癌病临床特征,提高临床医师对本病的认识。方法回顾性分析2003年2月至2015年5月就诊于河北医科大学第二医院脑膜癌患者的临床资料,包括性别、年龄、原发灶、临床表现、腰穿结果、影像学表现及治疗,并对部分患者进行随访,了解患者副反应和生存期。结果 94例脑膜癌者中,男39例,女55例,中位年龄55岁;原发灶来源于肺癌42例,原发灶不明30例,胃癌10例,乳腺癌及黑色素瘤各3例,卵巢癌2例,胰腺癌、腮腺癌、盆腔畸胎瘤、脑胶质瘤各1例;79例患者出现高颅压的症状,主要表现为头痛、恶心、呕吐;85例患者经首次细胞学检查确诊为脑膜癌病;75例患者行头颅MRI平扫,其中颅内异常信号（性质不定）者20例,脑室扩张、脑积水者10例。40例患者行头颅MRI增强扫描,28例患者示颅内异常强化,其中19例患者出现脑膜强化;对部分患者进行随访,其中20例进行鞘内化疗患者的中位生存期是150 d（86-214d）,但是1例患者出现骨髓抑制。24例未进行鞘内化疗患者的中位生存期是28d（11-45d）,两组的生存期有统计学差异（χ^2=23.929,P〈0.05）。结论脑膜癌病多见于中老年人,原发灶以肺癌多见,临床表现以高颅压症状多见。脑脊液细胞学是诊断脑膜癌病的首选检查方法,头颅平扫、增强有助于诊断。鞘内化疗不良反应较少,可提高患者中位生存期,是治疗脑膜癌病的有效方法。
Objective To increase the awareness of meningeal carcinomatosis（MC） for clinical physician by summarizing the clinical features of MC.MethodsThe clinical data of MC patients who were admitted to the second hospital of hebei medical university from February, 2003 to May, 2015 were analyzed retrospectively, including gender, age, primary tumor, clinical manifestation, the results of lumbar puncture, imaging findings and treatment. We also followed up some patients to investigate the side effects and survival.ResultsA total of 94 patients was enrolled, including 39 male and 55 female and the median age was 55 years old. There were 42 cases with lung cancer, 30 cases with unknown primary cause, 10 cases with gastric cancer, 3 cases with breast cancer or melanoma, 2 cases with ovarian cancer, 1 case with pancreatic cancer, 1 case with parotid gland and 1 case with pelvic teratoma,or glioma. Seventy-nine patients presented with high cranial pressure, including headaches, nausea and vomiting. After admission, cerebrospinal fluid cytology examination detected the tumor cells and confirmed the diagnosis in 85 cases. Brain MRI scan showed intracranial abnormal signals that were not differentiable in 20 patients, and ventricular expansion or hydrocephalus in 10 patients. Forty patients received brain MRI enhancement scanning. Abnormal enhancement were present in 28 patients, including menin-geal enhancement in 19 patients. Among the patients on follow-up, 20 patients were accepted intrathecal chemotherapy and the median survival was 150 days（86 days-214 days）. However, chemotherapy induced bone marrow suppression in one patients. The median survival was 28 days（11 days to 45 days） in 24 patients without intrathecal chemotherapy. The survival time of the two groups was statistically difference（χ^2= 23.929, P〈0.05）.ConclusionMC are more common in middle-aged and elderly people. lung cancer is the most common primary source of MC and high cranial pressure is one of the most common clinical manifestations. Cerebrospinal fluid cytology is the first choice for the diagnosis of MC and brain scan and enhanced scan are also helpful. Intrathecal chemotherapy can improve the patients survival, which is an effective and safe method for treatment of MC.
出处
《中国神经精神疾病杂志》
CAS
CSCD
北大核心
2015年第12期715-719,共5页
Chinese Journal of Nervous and Mental Diseases
基金
2014年度河北省医学适用技术跟踪项目
关键词
脑膜癌病
脑脊液细胞学
鞘内化疗
Meningeal carcinomatosis
Cerebrospinal fluid cytolog
Intrathecal chemotherapy
