高温隔离灌注化疗在下肢骨与软组织肉瘤保肢治疗中的价值与限度  

The Value and Limitation of Chemotherapy by Hyperthermic Isolation Perfusion in the Limb salvage Surgery of Bone and Soft Tissue Sarcomas

作　　者：杨迪生[1] 范顺武[1] 陶惠民[1] 何荣新[1] 叶招明[1] 徐世伟[1] 陈芳[1] 黄宗坚[1] 

机构地区：[1]浙江医科大学附属第二医院

出　　处：《中国矫形外科杂志》1997年第5期347-349,共3页Orthopedic Journal of China

摘　　要：为了减低肢体恶性肿瘤治疗中保肢手术的局部复发率，我们从１９９０年开始对５７例下肢ⅡＢ期骨与软组织肉瘤进行术前顺铂或卡铂高温（４１～４３°Ｃ）隔离灌注化疗，同时结合静脉滴注阿霉素。本组进行保肢手术４７例、截肢手术１０例。术前化疗后显示９１％患者局部疼痛完全消失；９５％肿块明显缩小；８９．５％关节活动度改善。术后病理检查肿瘤坏死率９０％～１００％为完全反应者４９例（８６％）；６０％～９０％为部分反应者５例（８．８％）；６０％以下为无反应者３例（５．２％）。术后随访２～５年的２６例保肢者中局部复发２例（７．７％）；术后３年以上随访者２６例，无病存活１６例（６１．５％）。作者认为本法局部效果非常良好，十分利于施行保肢术手，但无助于提高存活率，对截肢者不必应用。In order to reduce local recurrence of malignant tumors in the extremities after the limb salvage surgery,since 1990,57 patients with stage IIB sarcomas of bone and soft tissue in the lower extremities received cisplatinum or carboplatinum by hyperthermic(41° C 43° C)isolation perfusion combined with intravenous doxorubicin administration in preoperative chemotherapy.47 patients of them were treated with limb salvage procedures,10 patients with amputation.After preoperative chemotherapy,pain relief was obtained in 91% of patients,tumor mass appeared remission in 95% of patients and joint motion got improvement in 89 5%of them.According to the postoperative pathology,49 cases were classified as “complete response”with 90%to 100%necrosis of the tumor,5 cases as “partial response”with 60% to 90% necrosis,3 cases as “no response”under 60%necrosis.The follow up period lasted from 2 to 5 years,two patients had local recurrence.26 cases were followed up for more than three years,disease free survival rate was 61 5%.The authors held that the measure was proved to be very effective and it provided many advantages for limb salvage surgery,nevertheless it can′t improve the survival rate.The method are not indicated for the amputation cases.

关 键 词：软组织肉瘤 下肢骨 高温隔离灌注 保肢手术 

分 类 号：R739.96[医药卫生—肿瘤]