【作者】 李鹏； 李文良； 王晓光；

【Author】 Li Peng Li Wen-Liang Wang Xiao-Guang ect Tianjin Medical University Cancer Institute and Hospital, zip code: 300060

【机构】 天津医科大学附属肿瘤医院；

【摘要】 目的:本文主要探讨手术治疗脑转移瘤的重要价值。方法:对我科自1999年2月至2004年8月手术治疗的脑转移瘤病例进行回顾性分析。手术适应症:1)单发实体肿瘤,特别是2cm以上不适宜放射治疗的。2)颅脑随为多发,但有明确的责任病灶被认为引起严重的临床症状或危及生命。3)患者原发肿瘤稳定,全身情况良好,无恶病质及严重肝肾功能不良。4)患者的预期生存期大于3～6个月。手术方法为根据 MRI定位开颅手术,术后两周常规进行全脑放疗,如为多发可选择加X-刀治疗。放疗后根据复发肿瘤给于全身放疗。本组病例中2例病人术后接受了原发肿瘤的手术治疗。结果:肿瘤术中全切54例,次全切5例,部分切除2例。无术中死亡, 1例病人术后1周因急性左心衰死亡。术前症状消失34例,明显缓解20例,无改善4例,加重3例。术后病理肺癌45例(腺癌21例,鳞癌14例,腺鳞癌6例,小细胞癌4例),乳癌3例, 恶黑3例,膀胱移行细胞癌2例,甲状腺乳头状癌2例,胸腺癌1例,绒癌1例,肉瘤1例,消化道腺癌1例,肾透明细胞癌1例,腺样囊腺癌1例。随访半年生存率92％,一年生存率为82％,两年生存率为16％。结论:手术治疗是治疗脑转移瘤非常可靠、安全、有效的方法,可以延长生命,减轻痛苦,改善生存质量,并为晚期病人赢得进一步治疗的机会。约有1／ 3的病人以神经系统症状为首发症状,约有5—8％的患者通过系统的检查仍不能找到原发病灶。通过手术治疗可以为这样的患者明确病理诊断,推断出原发病灶,再进行系统的肿瘤综合治疗。对于多发病灶,如果有明确的责任病灶就可以手术,有两个以上责任病灶,邻近的可以在一个较大的骨窗下一并切除,相距较远的只要病人条件允许、位置表浅的可以考虑一次手术开两个骨窗切除。原位复发和其它部位新发的单发病例,只要原发病情稳定,身体条件允许,可以选择再次手术治疗。当然脑转移瘤的治疗要严格的掌握适应症,毕竟手术的对象是肿瘤晚期病人,同时手术治疗应尽可能的减少损伤,保证术后病人的生存质量。更多还原

【Abstract】 Objective: To evaluate surgical treatment of brain metastases. Methods: A retrospective statistic study was performed after all (the cases of surgical treatment of brain metastases in our department of Neurosur-gery rom Feb.1999 to Aug.2004)clinical information transformed into qualitative data, he performed treatments were surgery, regular whole brain radiation therapy and Chemotherapy after operation. Results: Among all the cases, 56 cases were total resection, 5 cases near total resection and 2 cases partial resection. No case died during operation and 1 case died of acute left heart failure in 1 week after operation. Among all the cases after operation, 34 cases had no symptom, 20 cases were markedly relieved, 4 cases were unimproved and 3 cases were aggravated. Among all the cases after operation, survival rate after 6 months is 92%, after 1 year 82%, and after 2 years 16% (exclusive of the cases in 2004). conclusion: Surgical treatments are very reliable, safe and effective, which can prolong patients’ lives, decrease pain, even improve their live qualities and accept opportunities of further treatment for the adult patients.更多还原