以癫痫为首发症状的肺癌脑转移21例临床分析

Brain metastases of lung cancer with epilepsy as the initial symptom

目的探讨成人肺癌脑转移引起癫痫的病因。方法回顾性分析我院2000年3月～2007年12月收治的21例经确诊为肺癌、但首发症状脑转移引起癫痫的患者资料。结果在21例患者中,鳞癌1例,鳞腺癌3例,腺癌10例,小细胞癌7例;其中单纯部分性发作6例,复杂部分性发作3例,单纯部分性发作继发全面性强直-阵挛发作1例;肌阵挛发作1例,全面性强直-阵挛发作(GTCS)10例。转移部位及数量:共有转移灶56个,分别为额叶9个,颞枕叶6个,顶枕叶7个,顶叶5个,颞叶12个,枕叶9例,岛回2例,海马回2个,扣带回2个,边缘回1个,小脑1个。1处转移5例,2处转移6例,3处6例,多处4例。治疗方法:常规放化疗14例,肺部手术3例,头部外科减压手术及γ刀各3例,放弃治疗1例。生存时间:最短3月,最长35月,平均12.6月。结论成人,尤其是40岁以上的成年人,如不明原因引起癫痫发作时,应考虑脑转移瘤的可能,尤其是要考虑肺癌脑转移。

Objective To explore the causes of metastatic encephaloma of lung with epilepsy as the initial symptom in adult. Method The clinical data of 21 patients with confirmed lung cancer with epilepsy as the initial symptom from March 2000 to December 2007 in our hospital were analyzed retrospectively. Result The cancer types included squamous carcinoma （1 case）, squamous adenocarcinoma （3 cases）, adenocarcinoma （10 cases）, and small cell undifferentiated carcinoma （7 cases）. Epilepsy included simple partial seizure （6 cases）, complex partial seizure （3 cases）, simple partial seizure go on generalized tonic-clonic seizure （GTCS） （1 case）, myoclonic seizure （1 case）, and generalized tonic-clonic seizure （GTCS） （10 cases）. There were a total of 56 foci in the 21 patients, which included the frontal lobe （9 foci）, temporal - occipital lobe （ 6 foci）, parietal - occipital lobe （ 7 foci）, parietal lobe （ 5 foci） temporal lobe （ 12 foci）, occipital lobe （9 foei）, insular gyrus （2 foci）, hippocampal suleus （2 foei）, cingulate gyrus （2 foci）, limbic lobe （1 focus）, and cerebellum （1 focus）. Metastatic sites included. one site （5 cases）, two sites （6 cases）, three sites （6 cases）, and muihiple sites （4 cases）. Routine radiotherapy and chemotherapy were performed in 14 cases; operation of lung was performed in 3 cases; surgical decompression of brain was performed in 3 cases, γknife of brain in 3 cases, and abandon treatment in 1 case. The survival period ranged 3 monthes to 35 monthes （ average 12. 6 monthes）. Conclusion In adults （ especially over 40 years old）, bran metastases of lung cancer with epilepsy as the initial symptom should be carefully monitored.