下肢恶性骨肿瘤顺铂热灌注治疗的血铂浓度测定  

Cisplatin blood concentration of patients with malignant bone tumor of lower extremity with out discarding blood after hyperthermic antiblastic perfusion

作　　者：杨蕴[1] 宋金钢[1] 朱靖[2] 滕胜[1] 马育林[1] 张瑾[1] 邢汝维[1] 

机构地区：[1]天津医科大学附属肿瘤医院骨软科,300060 [2]天津医科大学药学院

出　　处：《中华骨科杂志》2003年第6期335-338,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨顺铂热灌注(hyperthermicantiblasticperfusion,HAP)治疗下肢恶性骨肿瘤后不弃血的可行性。方法下肢恶性骨肿瘤患者40例,骨肉瘤31例,骨恶性纤维组织细胞瘤9例。根据Enneking骨肿瘤外科分期标准均为ⅡB期。弃血组(10例):HAP术后弃血200ml;不弃血组(25例):HAP术后不弃血;静脉化疗组(5例):顺铂静脉输注。弃血组和不弃血组在HAP术中给药后3、30、60min取局部和全身血样;弃血组和不弃血组HAP术后和静脉化疗组化疗后0(即刻)、0.5、1、2、4、8、12、24、48、72h取全身血样,测定血铂浓度。结果HAP术中各个时间点局部血铂浓度均明显高于全身血铂浓度。不弃血组与弃血组比较,HAP术后除0min时血铂浓度高于弃血组外,其余各时间点血铂浓度差异均无显著性,不弃血组全身血铂浓度与静脉化疗后全身血铂浓度相近。弃血组和不弃血组均未见明显不良反应。所有患者保肢手术前Enneking骨肿瘤外科分期均由ⅡB期转为ⅡA期。结论顺铂HAP后不弃血对于下肢恶性骨肿瘤保肢手术是可行的,在局部区域治疗的同时又兼做一次全身化疗。Objective To explore the possibility of non-discarding blood after cisplatin hyperther-mic antiblastic perfusion(HAP)in treating the patients with malignant bone tumor of lower extremity.Methods Forty patients consisted of 31osteosarcomas and9malignant fibrous histiocytomas of bone.The clinical stages were wholly classified intoⅡB stage according to Ennekings surgical staging system for muscu-loskeletal tumors.The patients were divided into three groups:group1:discarding blood group(10cases),in whom200ml of the400ml blood remaining in heart-lung machine was discarded after HAP;group2:Non-discarding blood group(25cases),the blood remaining in heart-lung machine was not discarded after HAP and re-infused into systemic circulation;group3:systemic chemotherapy group(5cases),cisplatin was infused intravenously.The regional and the systemic blood cisplatin concentrations were determined at3,30and60minutes during HAP,and the systemic blood cisplatin concentrations were determined at0,0.5,1,2,4,8,12,24,48and72hours after HAP in the group1and group2.While1h after cisplatin infusion in-tra venously in the group3,the blood cisplatin concentration were also measured.Results The regional blood cis platin concen tra tions were high er than that in systemic blood at the time during HAP.The systemic blood cisplatin concen trations after HAP,ex cept at0minute in the group2were higher than that in the group1,there were sig nificant statistic differences between the two groups.The systemic blood cisplatin con-cen trations after HAP in the group2were simi lar to that after systemic chemotherapy.No severe adverse ef-fects in the group1were found.The Ennek ings surgical stagings for the tumors were turned fromⅡB intoⅡA in all the patients.Conclusion The method of non-discarding blood after HAP is available,it is not only local treatment ,but also systemic chemotherapy in the patients with malignant bone tumor of lower ex-tremi ty for limb-salvage surgery.

关 键 词：治疗 恶性骨肿瘤 下肢 HAP 顺铂 全身 热灌注 浓度测定 血样 给药 

分 类 号：R738.1[医药卫生—肿瘤] R735[医药卫生—临床医学]