皮下放置Ommaya囊并经皮穿刺局部化疗治疗颅内多发及复发肿瘤  

Treatment of multiple or recurrent intracranial tumors with local chemotherapy by hypodermatic Ommaya reservoir

作　　者：张晶[1] 刘藏[1] 侯瑞光[1] 

机构地区：[1]首都医科大学附属北京友谊医院神经外科,100050

出　　处：《中华医学杂志》2014年第3期212-214,共3页National Medical Journal of China

摘　　要：目的探讨皮下放置Ommaya囊并经皮穿刺注入甲氨蝶呤局部化疗治疗颅内多发及复发肿瘤。方法回顾分析首都医科大学附属友谊医院2010年1月至2013年9月收治的颅内多发及复发肿瘤45例病人的临床资料并随访结果。45例中全部放置Ommaya囊。41例分流管置于脑室，3例置于瘤腔，1例置于囊性瘤腔。术后经皮穿刺Ommaya囊注入甲氨蝶呤局部化疗。结果化疗疗程结束后复查头颅MR，32例颅内病灶基本完全消失；10例病灶明显减小、减少；1例同时伴有椎管内种植转移肿瘤症状改善不明显。2例在化疗期内死亡，1例死于腹腔感染中毒性休克，1例死于肺部感染。随访32例，7例死亡。1例出现手术并发症，二次手术调整分流管，化疗结束后复查头颅MR，病变完全消失。结论放置Ommaya囊手术创伤很小，病人耐受性好，术后经皮穿刺Ommaya囊注入甲氨蝶呤局部化疗，方便快捷，脑室或瘤腔给药减少化疗药物的全身不良反应，提高化疗药物疗效，可在一定程度上延长生存时间，改善生存质量。Objective To explore the treatment of multiple or recurrent intracranial tumors by hypodermatic placement of Ommaya reservoir and local chemotherapy with methotrexate. Methods Retrospective analyses were performed on the clinical data of 45 cases with muhiple or recurrent intracranial tumors at Friendship Affiliated Hospital, Capital Medical University from January 2010 to September 2013. All 45 cases had a placement of Ommaya reservoir under skin. Shunt tubes were placed in ventricle （ n = 41 ）, cystic tumor cavity （n = 3） and tumor cavity （ n = 1 ）. Methotrexate was injected postoperatively into Ommaya reservoir by transeutaneous paracentesis. Results After local chemotherapy, head magnetic resonance imaging （MRI） re-examinations were performed. Tumors disappeared （n = 32 ）, shrunk significantly （n = 10） and had no significant improvement of symptoms with spinal implantation metastasis （ n = 1 ）. During chemotherapy, there were two mortalities due to septic shock and heart failure （ n = 1 each）. Follow-ups were conducted for 32 cases and 7 of them died. One case had operation-related complications. After an adjustment of shunt tube, symptoms and signs improved. And after local chemotherapy, tumor disappeared on MRI. Conclusion The placement of Ommaya reservoir is mini- invasive and well-tolerated. And local chemotherapy with methotrexate by Ommaya reservoir is convenient and it may reduce systemic side effects, improve the efficacy of chemotherapy drugs, prolong survival time and enhance quality of life.

关 键 词：OMMAYA囊 颅内多发及复发肿瘤 局部化疗 

分 类 号：R739.41[医药卫生—肿瘤]