恶性或侵袭性骨肿瘤患者的微波高温治疗  

Treatment of malignant or aggressive bone tumors with microwave induced hyperthemia

作　　者：范清宇[1] 马保安[1] 郭爱林[1] 李玉林[1] 叶军[1] 周勇[1] 沈万安[1] 裘秀春[1] 

机构地区：[1]第四军医大学唐都医院骨科

出　　处：《中华外科杂志》1997年第8期484-487,I071,共5页Chinese Journal of Surgery

摘　　要：为探讨治疗骨肿瘤新的保肢手术，作者选用了一种利用微波植入式天线阵诱导高温的全新手术方法，治疗各类骨肿瘤患者１１２例，其中７９例恶性，３３例良性；恶性肿瘤患者术后给予免疫治疗，并检测了患者手术前后的免疫功能。术后随访３～５０个月，平均２３个月。５例椎体恶性肿瘤手术目的主要在于减轻症状；１０７例保肢手术的患者，１０例局部复发截肢，９７例局部控制良好；７４例肢体恶性肿瘤患者中，１２例术后４个月～２年内肺部转移，８例术后病理性骨折。４０例随访２年以上且肿瘤无复发、转移患者中的２９例关节功能优，１１例良。关节功能大多良好，稳定无痛，屈伸功能正常。ＳＰＥＣＴ检查表明：灭活的肿瘤骨段在１年或更长的时间内出现再血管化。经过高温和免疫疗法后多数患者的免疫状态得到改善。作者认为，微波高温手术和辅助性免疫疗法是一种治疗骨肿瘤安全、有效的新手段。Limb sparing procedures have been well established for dealing with malignant bone tumors.Unfortunately,these procedures have different problems.We used an alternative operation combined with microwave induced hyperthemia to modify the surgical methods.Thermotherapy with microwave intracorporeal irradiation was used to treat 112 patients with bone tumors.In this series, 79 had malignant tumors and 33 aggressive benigh tumors.Postoperatively, immune therapy was carried out regularly.The patients immunologic functions were monitored by assay of the subpopulation of T cells,IL 2 and sIL 2R (soluble IL 2 receptor).Follow up varied from 3 to 50 months (mean 23 month)s.Excluding 5 patients with malignancy in the vertebrae treated for palliation,107 were evaluated by oncological and orthopedic criteria. 10 patients had local recurrence and required amputation.The remaining 97 had excellent local control.In 12 of the 74 patients with malignancy of the extremities,lung metastasis occurred 4 months to 2 years after surgery.Pathological fracture occurred at devitalized bone in 8 patients.In 29 out of 40 tumor free cases followed for more than 2 years,the knee joints functioned properly with almost full range of motion.Single photon emission computered tomography (SPECT) study revealed revascularization of the devitalized tumor bearing bone segment could accomplish in one year or more.The immune state was improved after thermotherapy plus immunotherapy in the majority of patients.These results indicated that the use of microwave hyperthermia and adjuvant immunotherapy in the surgical treatment of bone tumors can be considered a definitive procedure,which is safe and well tolerated.

关 键 词：骨肿瘤 免疫疗法 微波疗法 

分 类 号：R738.105[医药卫生—肿瘤]