肺癌脑膜转移11例临床分析

摘要

Objective:To investigate the clinical manifestations,diagnosis,therapy and prognosis of leptomeningeal metastasis secondary to lung cancer.Methods:Clinical features of 11 cases with leptomeningeal metastasis secondary to lung cancer were retrospectively analyzed.Results:All the 11 cases were adenocarcinoma with symptoms of central nerve system such as vomiting and headache at the diagnosis of leptomeningeal metastasis.The radiological manifesta-tions were enhancement of meninge,ventricular enlargement and brain metastasis.Increased intracranial pressure was found in 9 patients.Malignant cells were identified in cerebrospinal fluid in all the patients.Nine patients were treated with combined treatment,including systemic chemotherapy,targeted therapy with EGFR -TKI,intrathecal chemother-apy,ventriculoperitoneal shunt and whole brain radiotherapy.The median survival of the patients was 3 months.Con-clusion:Leptomeningeal metastasis secondary to lung cancer is one of the most severe complications of advanced lung cancer.Clinical manifestations,radiological featrues facilitate its diagnosis and the golden standard of diagnosis is i-dentification of malignant cells in cerebrospinal fluid.Combined treatment relieves symptoms and improves survival.%目的：探讨肺癌合并脑膜转移的临床表现、诊断、治疗和预后。方法：回顾分析11例肺癌脑膜转移患者的临床资料。结果：11例腺癌患者均有头痛、呕吐等神经系统症状，影像学表现为脑膜强化、脑室扩张及脑转移。9例患者颅内压升高，11例患者脑脊液均发现肿瘤细胞。9例患者接受了综合治疗，包括全身化疗、靶向治疗、鞘内化疗、脑室腹腔分流术、全脑放疗。中位生存期3个月。结论：脑膜转移是晚期肺癌并发症之一，根据临床表现、影像学及脑脊液检查可明确诊断。给予鞘内化疗、靶向治疗等综合治疗可减轻症状、延长生存。