鞘内输注系统植入术建立脑膜转移癌患者鞘内化学治疗通路的可行性  

Feasibility of intrathecal chemotherapy through intrathecal drug delivery system implantation for patients with leptomeningeal metastases

作　　者：杨磊 刘潇莲 田德民[1] 鞠衍馨 Yang Lei;Liu Xiaolian;Tian Demin;Ju Yanxin(Department of Painology,Weihai Municipal Hospital,Weihai City,Shandong Province 264299,China;Department of General Oncology,Weihai Municipal Hospital,Weihai City,Shandong Province 264299,China;Department of Anesthesiology,970th Hospital of Joint Support Force of Chinese People's Liberation Army,Weihai City,Shandong Province 264200,China)

机构地区：[1]威海市立医院疼痛科,威海市264299 [2]威海市立医院肿瘤综合科,威海市264299 [3]解放军联勤保障部队第九七〇医院麻醉科,山东省威海市264200

出　　处：《中华疼痛学杂志》2023年第4期581-586,共6页Chinese Journal Of Painology

摘　　要：目的探讨脑膜转移癌患者行经腰椎穿刺鞘内输注系统植入术(IDDS)建立鞘内化学治疗(化疗)通路的可行性。方法回顾性分析2020年6月至2021年3月威海市立医院疼痛科收治的12例因脑膜转移癌拟行鞘内化疗患者,男4例,女8例,年龄42~68岁,所有患者均行IDDS术,术后经鞘内输注通路注射培美曲塞二钠行鞘内化疗。收集鞘内化疗后患者疼痛数字等级评分(NRS)及颈项强直、恶心呕吐、四肢无力及嗜睡等临床症状改善情况,记录患者生存时间及手术和化疗并发症,以及不良反应发生情况。结果12例脑膜转移癌患者均顺利完成了IDDS术,并经此通路行鞘内化疗。鞘内化疗后,患者NRS评分较化疗前显著降低[(2.5±0.6)分比(7.1±0.7)分,t=15.94,P<0.001];颈项强直、恶心呕吐、四肢无力及嗜睡等临床症状较化疗前有效改善;患者鞘内化疗后中位生存期105 d(95%CI∶84.6~125.4)。所有患者均未见出血、血肿、感染及脑脊液漏等手术相关并发症。鞘内化疗后,2例患者出现"癫痫样抽搐",对症处理后缓解。结论经腰椎穿刺鞘内输注系统植入术可为脑膜转移癌患者提供安全、有效的鞘内化疗通路。Objective To explore the feasibility of establishing an intrathecal chemotherapy pathway through implanted intrathecal drug delivery system(IDDS)for patients with leptomeningeal metastases.Methods Twelve patients with leptomeningeal metastases were retrospectively reviewed,4 males and 8 females,aged from 42 to 68 years,in the Painology of Weihai Municipal Hospital from June 2020 to March 2021.All patients underwent intrathecal infusion system implantation via lumbar puncture.Pemetrexed disodium was injected via the intrathecal infusion system for intrathecal chemotherapy.Numerical rating scale(NRS),neck stiffness,nausea and vomiting,limb weakness,lethargy and other clinical symptoms were recorded after the intrathecal chemotherapy.Survival time,chemotherapy complications and adverse reactions were also recorded.Results All patients were successfully established the intrathecal chemotherapy pathway and received chemotherapy.NRS after the intrathecal chemotherapy was significantly lower than that before the intrathecal chemotherapy[(2.5±0.6)vs.(7.1±0.7),t=15.94,P<0.001].The neck stiffness,nausea and vomiting,limb weakness and lethargy,were improved significantly.Median survival time was 105 days(95%CI∶84.6-125.4)after the intrathecal chemotherapy.No operation-related complications such as hemorrhage,hematoma,infection and cerebrospinal fluid leakage were found.After the intrathecal chemotherapy,two patients developed"epileptiform convulsions",which resolved after symptomatic treatment,and no other serious complications occurred.Conclusion The implantation puncture intrathecal drug delivery system through lumbar puncture can provide a safe and effective intrathecal chemotherapy pathway for patients with leptomeningeal metastatic carcinoma.

关 键 词：输注泵 植入型 蛛网膜下腔 化学治疗 鞘内 脑膜转移癌 

分 类 号：R739.45[医药卫生—肿瘤]