鼻咽癌患者放疗后囊性脑坏死的外科手术治疗  

Surgical treatment of cystic brain radionecrosis in patients with nasopharyngeal carcinoma

作　　者：谢海涛[1] 谢学敏[1] 隋立森[1] 伍犹梁[1] 余佳彬[1] 韩富[1] XIE Haitao;XIE Xuemin;SUI Lisen;WU Youliang;YU Jiabin;HAN Fu(Department of Neurosurgery of the Traditional Chinese Medicine Hospital of Guangdong Province,Guangzhou 510120,China)

机构地区：[1]广东省中医院神经外科,广州510120

出　　处：《实用医学杂志》2019年第1期92-95,共4页The Journal of Practical Medicine

基　　金：广东省中医药管理局基金项目(编号:20151206);首都医科大学重点实验室开放课题(编号:2015DXBL04)

摘　　要：目的探讨鼻咽癌放疗后囊性脑坏死患者外科手术治疗策略、疗效及影响因素。方法回顾性分析8例囊性鼻咽癌放射性脑坏死手术患者的临床资料、手术时机、手术方式选择、疗效及术后随访情况。结果所有病例坏死主要累及颞叶,且合并囊性坏死;囊性变中,行Ommaya囊植入术4例,其中2例行双侧植入;开颅手术清除坏死4例,3例同时行去骨瓣减压;术后随访,2例死亡,且死因均为吸入性肺炎,余6例长期生存;术后KPS评分(75±14)较术前(61±12)有改善(P <0.05)。结论鼻咽癌放疗后囊性脑坏死患者,除了传统开放外科手术治疗外,还可以根据坏死特点以及患者自身具体状态选择Ommaya囊植入这一微创手术。Objective To explore the surgical strategy,effect and influencing factors of cystic brain radionecrosis in patients with nasopharyngeal carcinoma.Methods The data of 8 patients with nasopharyngeal carcinoma who underwent surgery for cystic brain radionecrosis were analyzed retrospectively.The clinical data,surgical timing,surgical methods,efficacy and postoperative follow-up were studied.Results In all cases,necrosis was mainly involved the temporal lobe.Cystic necrosis was showed in 5 cases.4 cases of them were implanted with Ommaya reservoir,2 cases were bilateral implantation.The rest patients underwent craniotomy to remove necrosis,3 cases underwent decompressive craniotomy in the same time.During follow-up,2 patients died of aspiration pneumonia and 6 patients survived with good condition.The postoperative KPS score(75±14)was improved,compared with the preoperative one(61±12)(P﹤0.05).Conclusion According to the characteristics of brain necrosis and the specific conditions of patients,minimally invasive surgery with Ommaya cyst implantation can also be used as an effective treatment,except traditional craniotomy.

关 键 词：鼻咽癌 放射性囊性脑坏死 外科手术 

分 类 号：R739.63[医药卫生—肿瘤] R651.1[医药卫生—临床医学]