本文關(guān)鍵詞：食管鱗癌治療后腦、脊髓多發(fā)轉(zhuǎn)移一個(gè)案報(bào)道及文獻(xiàn)復(fù)習(xí)　出處：《山東大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 食管癌腦 脊髓轉(zhuǎn)移 核磁共振 放射治療

【摘要】：[研究背景及目的]食管癌是常見的惡性腫瘤之一,晚期食管癌易發(fā)生血行轉(zhuǎn)移,以肝、肺、骨多見,食管癌的腦轉(zhuǎn)移發(fā)生率極低,脊髓轉(zhuǎn)移更為罕見。本文通過分析一例食管鱗癌放化療后腦、脊髓多發(fā)轉(zhuǎn)移,適形放療后癥狀緩解的患者,并復(fù)習(xí)國內(nèi)外文獻(xiàn),探討食管癌腦、脊髓轉(zhuǎn)移的特征及高危因素、早期診斷、綜合治療及預(yù)后。[方法]本文首先報(bào)道一例因進(jìn)食梗阻感,行胃鏡活檢病理示胸中段中低分化食管鱗狀細(xì)胞癌,手術(shù)探查無法切除的ⅢC期患者,經(jīng)2周期TP方案誘導(dǎo)化療后復(fù)查CT示部分緩解(PR),后給予食管原發(fā)病灶及淋巴結(jié)引流區(qū)三維適形放射治療和同步TP方案化療2周期,放療劑量5940cGy/33f/6w+,再次復(fù)查CT示病灶較前好轉(zhuǎn)。治療結(jié)束后4個(gè)月患者出現(xiàn)頭痛、頭暈,顱腦核磁共振(MRI)示雙側(cè)大腦、小腦及透明隔區(qū)多發(fā)轉(zhuǎn)移,給予全腦放療5040cGy/28f/5w+,復(fù)查顱腦CT療效評價(jià)示PR,但顱腦放療開始1周后患者出現(xiàn)嚴(yán)重脊髓壓迫征,行脊椎MRI示頸、胸、腰椎管及椎體多發(fā)轉(zhuǎn)移,給予脊髓轉(zhuǎn)移灶的適形放療4000cGy/20f/4w,患者脊髓壓迫征明顯好轉(zhuǎn),放療結(jié)束后4.5個(gè)月患者死亡。其次在中國知網(wǎng)、pubmed等多個(gè)數(shù)據(jù)庫中檢索關(guān)鍵詞“食管癌腦轉(zhuǎn)移”,獲得相關(guān)文獻(xiàn),并選擇性閱讀文獻(xiàn)摘要及全文。[結(jié)論]根據(jù)本例患者的治療經(jīng)驗(yàn)及復(fù)習(xí)文獻(xiàn)得出,分化差、分期晚的胸段原發(fā)性食管癌易發(fā)生腦轉(zhuǎn)移,病理類型為小細(xì)胞癌的轉(zhuǎn)移率高。腦轉(zhuǎn)移的首發(fā)癥狀可能是疲勞、頭痛、癲癇、小腦功能紊亂。MRI是診斷食管癌腦、脊髓轉(zhuǎn)移優(yōu)于CT的可靠方式,但考慮到腦轉(zhuǎn)移的低發(fā)生率,不推薦作為原發(fā)性食管癌的常規(guī)檢查項(xiàng)目。放射治療是腦、脊髓轉(zhuǎn)移病灶的有效治療手段,臨床中可根據(jù)患者具體情況采用單純放療、手術(shù)或手術(shù)結(jié)合放療、化療的綜合治療措施,以提高患者的生存質(zhì)量和總生存時(shí)間。
[Abstract]:Background and purpose: esophageal carcinoma is one of the common malignant tumors in advanced esophageal cancer prone to hematogenous metastasis, liver, lung, bone, brain metastasis of esophageal cancer incidence rate is extremely low, spinal metastasis is more rare. Through analyzing cases of esophageal squamous cell carcinoma after chemotherapy, spinal metastasis after conformal radiotherapy, symptoms of patients, and to review the literature at home and abroad, to explore the early diagnosis of esophageal cancer in the brain, characteristics and risk factors of spinal metastasis, the treatment and prognosis. Method: first report a case because of obstruction, gastroscope biopsy showed low differentiation of middle thoracic esophageal squamous cell carcinoma, surgery exploration of unresectable stage C patients, after 2 cycles of TP chemotherapy after CT showed partial remission (PR), after primary esophageal lesions and lymph nodes in three-dimensional conformal radiotherapy and synchronous chemotherapy with TP for 2 weeks, radiotherapy dose of 5940cGy /33f/6w+, check CT lesions better than before. After the end of treatment of patients with 4 months of headache, dizziness, brain magnetic resonance imaging (MRI) in the bilateral brain, cerebellum and transparent septum area of multiple metastases, whole brain radiation therapy 5040cGy/28f/5w+, assessed by brain CT effect in PR, but the brain radiotherapy 1 weeks after the start of the patients severe spinal cord compression syndrome, spine MRI neck, thoracic, lumbar vertebral canal and vertebral metastases, give conformal radiotherapy 4000cGy/20f/4w spinal metastases, patients with spinal cord compression syndrome significantly improved, patients died 4.5 months after radiotherapy. Secondly China in HowNet, keywords esophageal cancer brain metastasis retrieval PubMed etc. a database, access to relevant literature, and selective reading literature abstracts and full conclusion.] according to the cases of treatment experience and review of the literature shows that the differentiation of thoracic, late stage primary non carcinoma brain metastases, disease Transfer type for small cell carcinoma of the high rate. The first symptom of brain metastases may be fatigue, headache, epilepsy, cerebellar dysfunction is.MRI diagnosis of esophageal cancer brain, a reliable method of spinal metastasis is better than CT, but considering the low incidence of brain metastasis, is not recommended as a routine examination of primary esophageal cancer. Radiotherapy is effective treatment of brain, spinal metastatic lesions, according to the specific circumstances of patients with clinical radiotherapy, surgery or surgery combined with radiotherapy and chemotherapy treatment, to improve the patient's quality of life and survival time.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.1

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