脑室腹腔分流加Ommaya囊置入配合放化疗治疗肺腺癌脑膜转移的临床观察

Clinical Research of Ventriculoperitoneal Shunt and Ommaya Reservoir Placement Combined with Chemoradiotherapy in Treatment of Leptomeningeal Metastases from Pulmonary Adenocarcinoma

目的探讨在放化疗的基础上给予患者脑室腹腔分流（VP）＋Ommaya囊置入治疗肺腺癌脑膜转移的有效性．．方法对39例我院确诊的肺腺癌脑膜转移患者的临床和随访资料进行回顾性分析。根据治疗方法的不同分成VP分流＋0mmaya囊置入组、单纯Ommaya囊置入组及非手术组。用Kaplan-Meier法进行生存分析并绘制生存曲线，组间差异分析采用Logrank检验。结果全组患者中位生存期为5．1月（0．6-26月），1年生存率为12．8％（5/39）。行VP分流术后患者体力状况评分平均提高18．2分（P=0．000），行VP分流＋Ommaya囊置入组与非手术组的中位生存期分别为7．8月和3．2月（X^2=8．450，P=0．015）结论肺腺癌脑膜转移患者预后差，在联合放化疗的基础上给予患者脑室腹腔分流术、经Ommaya囊行脑室内化疗等方式能够有效提高患者生存质量，延长患者的生存期，但尚需大样本临床研究证实，以及多中心之间的合作。

Objective To analyze the effectiveness of ventriculoperitoneal shunt and Ommaya reservoir placement in the treatment of Leptomeningeal Metastases （LM） from pulmonary adenocarcinoma on the basis of radiotherapy and chemotherapy. Methods The clinical and follow-up data of 39 patients who were diagnosed with LM from pulmonary adenocarcinoma was retrospectively reviewed. They were divided into 3 groups according to the different treatment methods, the group with ventriculoperitoneal shunt （VP shunt） and Ommaya reservoir placement, the group with Ommaya reservoir placement only and the group without operation. Survival was analyzed using Kaplan-Meier methodology and shown as survival curve. Log rank test was used to evaluate the differences among the groups. Results The median survival time of the entire group was 5.1 months （range： 0.6-26 months）. Survival rate of one year was 12.8% （5/39）. Karnofsky performance scale scores were significantly improved with a score of 18.2 after VP shut placement. The median survival time of the group with ventriculoperitoneal shunt （VP shunt） and Ommaya reservoir placement was 7.8 months, while only 3.2 months in the group without operation（ X^2=4.927, P=0.026）. Conclusion LM from pulmonary adenocarcinoma is correlated with poor prognosis. In this study, the quality and time of life are improved by the application of VP shunt and Ommaya reservoir placement. But clinical research and verification of large sample and multi-center cooperation are still needed.