酒精灭活再植术在骨肿瘤治疗中的应用  

Excision-alcoholization-replantation method in management of bone tumors

作　　者：丁易[1] 牛晓辉[1] 刘巍峰[1] 张清[1] 郝林[1] 刘文生[1] 鱼锋[1] 杨发军[1] 

机构地区：[1]北京积水潭医院骨肿瘤科,100035

出　　处：《中华骨科杂志》2011年第6期652-657,共6页Chinese Journal of Orthopaedics

摘　　要：目的评价酒精灭活再植术在骨肿瘤治疗中的作用。方法回顾性分析1965年8月至2003年8月应用酒精灭活再植保肢术治疗且随访资料完整的骨肿瘤患者191例，男102例，女89例；年龄10-62岁，中位年龄20岁。Enneking分期ⅡB期恶性肿瘤136例（骨肉瘤117例），ⅠB期恶性肿瘤25例，2期活跃性类肿瘤疾病1例，3期侵袭性类肿瘤疾病2例，3期侵袭性良性肿瘤27例。手术切除长度5-26cm，边缘切除30例、广泛切除161例。肿瘤学评价包括生存分析、局部复发率和转移率；并发症分析包括骨不愈合、灭活骨骨折和感染；根据Mankin评价系统评估术后功能。结果术后随访1～372个月，中位随访时间为32个月，52例死亡。ⅡB期肿瘤五年生存率为59％，IB期肿瘤五年生存率为90％，二者差异有统计学意义（P=0．02）。52例（27．2％，52／191）出现转移，51例（26．7％，51／191）局部复发。除外肿瘤因素的并发症发生率50.3％（96／191）。局部并发症包括骨不愈合33例（17.3％，33／191）、灭活骨骨折39例（20．4％，39／191）、再植物感染39例（20．4％，39／191）、内固定断裂15例（7．9％，15／191）、关节不稳定或半脱位5例（2．6％，5／191）。灭活骨五年生存率为55％。Mankin功能评价满意率50．3％（96／191）。最终141例（73．8％，141／191）获得保肢。结论骨肉瘤灭活再植在肿瘤学安全性方面与同期非灭活保肢方法治疗的骨肉瘤相同，其优势在于治疗费用低和匹配性好。Objective To evaluate the functional outcomes and complications of patients with bone tumors who were treated with the excision-alcoholization-replantation （EAR） method. Methods From August 1965 to August 2003, 191 patients treated with the EAR method who had suitable follow-up were evaluated in our department, including 102 males and 89 females with an average age of 20 years （range, 10-62）. On the basis of Enneking tumor staging, 136 patients were identified Ⅱ B stage, 25 Ⅰ B stage, and 30 invasive benign tumors and tumor-like lesion. The length of the resected part ranged from 5 cm to 26 cm, with marginal resection in 30 cases, wide resection in 116. The oneological parameters that were evaluated included survival of the patients, local recurrence, and metastasis. Complications included non-union, infection, and fracture of the grafts. Mankin evaluation system was used to assess functional outcomes. Results The mean follow-up time was 32 months （range, 1-372）, 52 patients died with disease at the final follow-up. Five-year survival rates of high grade sarcoma and low grade sarcoma were 59% and 90%, respectively, with statistical significance （P=0.02）. Lung metastasis were demonstrated in 52 patients （27.2%, 52/191）, 51 （26.7%, 51/191） had local recurrence. Except the tumor factor, the total complication rate was 50.3%（96/191 ）. Local complications included 33 nonunion （17.3%, 33/191）, 39 fracture of the grafts （20.4%, 39/191）, 39 infections of the graft （20.4%, 39/191）, 15 fracture of internal fixation （7.9%, 15/191）, 5 instability or semiluxation of the joint （2.6%, 5/191）. The 5-year survival rate of inactivated bone was 55%. On the basis of Mankin functional evaluation, the satisfied rate was 50.3%. At last there were 141 patients （73.8%, 141/191） preserved their extremities. Conclusion Compared to other methods in the same period, EAR method is considered on the same level of safety in oncology, which superiorities are economic-applicable to patients

关 键 词：骨肿瘤 乙醇 再植术 手术后并发症 

分 类 号：R738.1[医药卫生—肿瘤]