多发性骨髓瘤合并脊髓压迫症6例临床分析  

A clinical analysis of 6 cases of mutiple myeloma complicated with spinal cord compression syndrome

作　　者：张新华[1] 冉启杰[1] 徐彪[1] 周敏[1] 李菁媛[1] 宋森花[1] 刘龙龙[1] 徐德红[1] 

机构地区：[1]广州军区武汉总医院,武汉430070

出　　处：《内科急危重症杂志》2016年第4期290-293,共4页Journal of Critical Care In Internal Medicine

摘　　要：目的:探讨多发性骨髓瘤(MM)椎管内浸润导致脊髓压迫症(SCCS)的临床表现、诊断及治疗方法。方法:分析6例MM合并SCCS患者的临床特点、MRI及CT表现、不同治疗方法及疗效,并相关文献复习。结果:6例MM合并椎管内髓外浆细胞瘤(EMP)均发生在胸椎节段。患者从感觉双下肢麻木、腰背部疼痛起,在数小时至3 d内即进展至截瘫状态。经MRI或CT检查诊断为椎管内硬膜外占位性病变。6例中5例接受了治疗。2例接受手术及术后化疗者,1例肌力改善,另1例无效;单纯接受化疗1例无效;2例接受放疗者,均恢复行走,其中1例肌力恢复至5级,另1例4级。结论:MM合并SCCS多发生在胸椎节段,病情进展快,需尽快治疗。MRI可明确病变部位,以放疗效果最佳。Objective： To explore the clinical features,prognosis and treatment of spinal cord compression syndrome（ SCCS） caused by infiltration of multiple myeloma（ MM）. Methods： Clinical records,magnetic resonance imaging（ MRI）and computed tomography（ CT） scans,treatment and efficacy of 6 MM patients with SCCS caused by extramedullary plasmacytoma（ EMP） invasion of the spinal canal were analyzed retrospectively,and pertinent literature was reviewed. Results： All the 6 patients had thoracic spinal cord involvement. It was within only a few hours to 3 days that symptoms of backache and numbness of lower limbs progressed to paraplegia for all the patients. EMP invasion was confirmed by MRI,CT and histopathological analysis. Five patients received therapy. Two patients underwent surgery followed by chemotherapy consisted of bortezomib-containing regimens and other combination therapies,the lower limb muscle strength recovered from 0 degree to 3degree for one patient,and unimproved for another; One patient received chemotherapy alone,whose muscle strength was unimproved too; Two patients who received radiotherapy achieved complete recovery（ CR） or near CR of their muscle strength. Conclusions： The thoracic spinal cord is the common site of compression by EMP. The MM patients with SCCS must be diagnosed and treated as early as possible,and radiotherapy is the best choice of treatment for a majority of the patients.

关 键 词：多发性骨髓瘤 脊髓压迫症 髓外浆细胞瘤 

分 类 号：R551.3[医药卫生—血液循环系统疾病]