腦膜癌病臨床診治分析

張環環+何俊瑛+張志清

摘要：目的 探討腦膜癌病（MC）的臨床特點、診斷及治療方法。方法 回顧性總結32例確診為MC患者的臨床資料，包含年齡，原發灶，臨床表現，腰穿結果，影像學等。結果 32例MC患者中肺癌為原發灶的有19例，比例最高。腦膜癌病的臨床表現無特異性，最常見的癥狀可表現為頭痛頭脹、惡心嘔吐等。32例患者中首次腦脊液細胞學檢查發現腫瘤細胞有25例，陽性率為78.13%（25/32）。多次檢測可提高陽性率。MC通常腦實質無病灶，故無占位效應，核磁強化檢查有助于診斷，尤其是腦脊液細胞學陰性時。結論 臨床上對于不明原因的頭痛、惡心嘔吐等顱高壓癥狀患者，尤其既往有腫瘤病史，要考慮MC可能，完善核磁強化檢查，完善腰穿腦脊液檢查，目前腦脊液細胞學MGG染色是診斷MC的主要方法，增強核磁檢查對MC的診斷起到幫助。

關鍵詞：腦膜癌病；腦脊液；細胞學；診斷；臨床特點

Abstract：Objective To investigate the meningeal carcinomatosis（MC）of the clinical features，diagnosis and treatment.Methods Retrospectively summarized the clinical data of 32 cases diagnosed as MC patients，including age，primary tumor，clinical manifestations，imaging lumbar puncture results.Results 32 cases of lung cancer in patients with MC as the primary tumor in 19 cases，the proportion of the highest.The clinical manifestations of meningeal cancer are not specific，the most common symptoms can be expressed as headache，swelling，nausea and vomiting.In 32 patients，25 cases of tumor cells were found in the first CSF cytology test，the positive rate was 78.13%（25/32）.Multiple tests could increase the positive rate.MC usually no brain parenchymal lesions， so there is no space occupying effect，strengthen the MRI examination is helpful to the diagnosis of cerebrospinal fluid cytology especially negative.Conclusion For unexplained headaches，nausea and vomiting and other symptoms in patients with intracranial hypertension，especially tumor history，to consider the MC may improve magnetic，strengthen inspection，improve the cerebrospinal fluid check，at present， cerebrospinal fluid cytology MGG staining is the main method of diagnosis of MC，enhanced nuclear magnetic examination to help the diagnosis of MC.

Key words：Meningeal carcinomatosis；Cerebrospinal fluid；Cytology；Diagnosis；Clinical features

腦膜癌?。╩eningeal carcinomatosis，MC）又稱癌性腦膜炎，為惡性腫瘤轉移或彌漫性浸潤腦膜、脊髓蛛網膜下腔，而腦、脊髓內并無病灶發現[1]。在實體腫瘤患者中發生率約為5%[2]，但是尸檢發現可達到20%。其臨床表現多樣且不特異，神經系統表現可分為：大腦半球、顱神經、脊髓及脊神經根病變表現[3]。可表現為頭痛、精神異常、視力、聽力減退等，臨床醫生容易誤診，如誤診為腦血管病、結核性腦膜炎、蛛網膜下腔出血等。現收集2009年5月～2011年12月在我院診斷MC患者的臨床資料，進行回顧分析。

1 資料與方法

1.1一般資料 32例MC患者中，男18例，女14例。年齡29～73歲，平均年齡（56.85±9.96）歲。……