【作者】 李青；

【导师】 卜晖； 何俊瑛；

【作者基本信息】 河北医科大学 ， 神经病学（专业学位）， 2019， 硕士

【副题名】8例病例分析

【摘要】 目的:本文通过分析脑膜癌病(Meningeal carcinomatosis MC)合并脑积水患者的一般病例资料,以探讨此类疾病更好的治疗方案。方法:选取2014年10月~2018年12月河北医科大学第二医院神经内科收治的接受相关手术治疗的MC患者,对他们的临床表现、腰椎穿刺术检查结果、原发肿瘤的类型、合并脑积水的程度、鞘内化疗及手术治疗方案、术后症状缓解及KPS评分变化、术后并发症进行描述与分析。结果:本文共有8例MC患者,其中男性2例,女性6例。患者的平均年龄为59岁。术前临床表现包括头痛、颅神经损害、意识模糊、步态障碍、癫痫、认知功能障碍及尿便障碍等。8例患者脑脊液细胞学均发现肿瘤细胞,7例患者术前平均腰椎穿刺术压力升高。所有的患者都有明确的原发肿瘤诊断。文中有6例MC患者继发脑积水。1例行腰大池-腹腔分流术,1例行脑室-腹腔分流术,其余患者均接受了Ommaya囊置入术。7例患者术后接受了规律的鞘内化疗治疗。术后8例患者的临床症状都有好转,患者的平均KPS评分由36.25提升至58.75。3例患者出现术后并发症,术后平均生存时间为4.68个月(1-13个月),目前有2例患者仍存活。结论:1.对于伴有中枢神经系统症状及脑积水表现的肿瘤患者,应警惕MC的可能,早期发现、早期干预,必要时早期进行手术治疗。2.根据手术适应症选择手术方式,尽早的手术干预能够为其他治疗赢得时间和机会,术后规律的鞘内化疗及全身肿瘤的治疗使患者获得更长的生存时间及更好的生活质量。3.术中应严格无菌操作、避免反复穿刺,术后规律治疗,减少并发症的发生。更多还原

【Abstract】 Objective: The aim of this study is to analyse the clinical data of patients diagnosed with Meningeal carcinomatosis(MC)and hydrocephalus,so as to explore the better treatments for such diseases.Methods: Patients diagnosed with Meningeal carcinomatosis(MC)and treated by surgery from October 2014 to December 2018 admitted to the second hospital of Hebei medical university neurology department were reported and the objective is to analyze the clinical features,characteristics of primary malignancies,laboratory findings,therapeutic methods,changes in KPS score and postoperative complications.Results: Of the 8 cases,six were females and two were males.The mean age of the patients was 59 years old.Preoperative clinical manifestations,such as headache,cranial nerves damage,confusion of consciousness,gait disorder,epilepsy,cognitive dysfunction and urination and defecation disorders were included.Malignant cells were found in 8 patients in CSF cytology test and the average pressure of lumbar puncture was increased in 7 patients before surgery.All patients had a confirmed diagnosis of primary tumor.At the time of surgery,they all had been diagnosed with MC and 6 patients showed hydrocephalus.One patient received ventriculoperitoneal shunt and one patient accepted lumboperitoneal shunt,the others underwent Ommaya reservoir.After surgery,7 patients had been treated by intrathecal chemotherapy.The postoperative symptom was improved in 8 patients,the change of average Karnofsky performance status(KPS)scale was from 36.25 to 58.75.The postoperative complications of the surgeries occurred in 3 patients and mean survival time from surgery to death was 4.68 months(1-13),and 2 patients are still alive.Conclusions:1.For patients with tumors accompanied by central nervous system symptoms and hydrocephalus,the possibility of MC should be alerted.Early detection,early intervention,and early surgical treatment is also necessary.2.Early surgical intervention can provide time and opportunities for other treatments.Regular intrathecal chemotherapy and the systemic treatment of tumors after surgery can help patients to have a longer survival time and better quality of life.3.During the operation,sterility should be strictly controlled,and repeated puncture should be avoided.更多还原