手术治疗多发脑转移瘤25例分析

Surgical treatment of multiple intracranial metastatic neoplasms

目的探讨颅内多发转移瘤的手术适应证、手术方法及影响手术疗效的相关因素。方法手术治疗颅内多发转移瘤25例,共57个转移瘤。所有病例均一期开颅手术切除所有颅内病灶,术前未经放疗的病例术后均辅以放疗,所有病例术后均接受多个周期化疗,6例术后接受多次免疫治疗。结果22例肿瘤均获得全切,3例3个转移瘤因其邻近脑干等重要结构行次全切除,术后辅以γ-刀或X-刀治疗。无手术相关死亡,术后证状均获得不同程度改善,中位生存时间为13．7个月。结论恰当选择手术适应证进行包括手术治疗在内的综合治疗,可以显著改善一部分多发脑转移瘤患者的预后。

Objective To discuss the surgical indications, operative methods and clinical outcomes of multiple intracranial metastatic neoplasms. Methods 25 among 57 patients with multiple intracranial metastatic neoplasms underwent surgical treatment in our department. All intracranial tumors were resected in the first operation. The patients without Whole Brain Radiation Therapy （WBRT） before surgery received WBRT after surgery. All patients received chemotherapy for many periods postoperatively. 6 patients received immunotherapies after operation. Results Total resection of the tumors was achieved in 22 cases. Subtotal resection was performed in three cases, whose tumors were close to the important regions such as brainstem. There was no death associated with operations. Three cases of subtotal resection received gamma knife or X - knife treatment after operation. The preoperative neurological deficits were improved in all cases. Median survival was 13. 7 months. Conclusion Having comprehensive treatment for properly selected patients will improve the outcome of. the multiple brain metastases.