鼻咽癌放射治疗后继发颞叶囊肿患者的外科治疗

Surgical treatment of temporal lobe cysts after radiotherapy for nasopharyngeal carcinoma

目的探讨囊肿-腹腔分流、Ommaya囊植入及骨窗开颅三种手术方式治疗鼻咽癌放疗后继发颞叶囊肿的临床应用。方法选取2014年9月至2018年5月间南方医科大学附属小榄医院收治的11例鼻咽癌放射治疗后继发颞叶囊肿患者,根据手术方式不同进行分组,其中,囊肿-腹腔分流术组5例、Ommaya囊植入术组3例和骨窗开颅术组3例,比较三组患者治疗效果及术后并发症。结果术后11例患者临床神经功能缺失情况均有不同程度改善,术前6例意识障碍患者神志均转为清醒状态,3例行骨窗开颅患者,术后囊肿壁病理结果为神经胶质细胞增生样组织,未见异型性细胞存在,符合放射性脑病表现。11例患者均无手术相关感染发生,且术后评分明显上升,差异有统计学意义(P <0.05)。囊肿-腹腔分流术组患者的日常生活能力评分优于Ommaya囊植入术组与骨窗开颅术组,差异有统计学意义(P <0.05)。采用囊肿-腹腔分流术患者的焦虑评估量表(SAS)评分低于Ommaya囊植入术组与骨窗开颅术组,差异有统计学意义(P <0.05)。3年随访期间有2例患者死亡,死亡原因为慢性营养不良及肺部感染,骨窗开颅术组1例患者囊肿复发。结论囊肿-腹腔分流术创伤小,术中术后手术相关并发症少,远期随访囊肿未见复发,可作为治疗鼻咽癌放疗治疗后继发颞叶囊肿的首选治疗手段。

Objective To explore the clinical application value of cystoperitoneal shunt,Ommaya reservoir implantation and craniotomy for the treatment of temporal lobe cyst secondary to nasopharyngeal carcinoma. Methods Eleven patients with temporal lobe cysts after radiotherapy for nasopharyngeal carcinoma were included at Xiaolan Hospital Affiliated to Southern Medical University from September 2014 to May 2018. They were divided into a cystoperitoneal shunt group( 5 patients),an Ommaya reservoir implantation group( 3 patients) and a craniotomy group( 3 patients) based on the surgical method they received.The effect and postoperative complications were compared and analyzed. Results The postoperative clinical neurological deficits were improved in the 11 patients to varying degrees.,Six patients with consciousness before the operation became conscious,and craniotomy were performed in 3 patients. Pathological results showed gliosis within the cyst wall. No heterotypic cell was observed. It was consist with the presence of radiation encephalopathy. No surgery-associated infection occurred and the postoperative scores increased( all P < 0. 05). Activity of daily living was better in the cystoperitoneal shunt group than in the Ommaya reservoir implantation group( P < 0. 05). Scores of self-rating anxiety scale( SAS) were lower in the cystoperitoneal shunt group than in the Ommaya reservoir implantation group and the craniotomy group( all P < 0. 05). Two deaths occurred in the follow-up period due to chronic malnutrition and lung infection.Recurrence occurred in 1 patient in the craniotomy group. Conclusion Cystoperitoneal shunt can be used as the first choice for the treatment of temporal lobe cyst after radiotherapy for nasopharyngeal carcinoma because of less trauma,fewer intraoperative and postoperative complications without recurrence during the long-term follow-up.