皮下埋植式动脉化疗联用保肢手术治疗骨肉瘤  

Subdermal Implantable Intraaterial Chemotherapy Combined with Limb Preserving Operation Treatment for Bone Sarcoma

作　　者：杨淮海 

机构地区：[1]盐城市第一人民医院骨科,江苏盐城224001

出　　处：《河南肿瘤学杂志》2000年第1期23-24,共2页Henan Journal of Oncology

摘　　要：:目的　评价皮下埋植式动脉化疗联用保肢术治疗骨肉瘤的疗效。方法　15例骨肉瘤,男10例,女5例。年龄14～24岁。股骨下段14例,腓骨上段1例。Enneking分级:ⅡB期12例,ⅢA期3例。术前动脉置管导向化疗6次,行肿瘤边缘或扩大切除,病灶骨端酒精灭活,髓内针、骨水泥充填固定。术后继续化疗4次。结果　术前化疗后症状消失,X线、CT显示病灶缩小、硬化或消失,新骨形成,边缘相对整齐,手术所见肿瘤组织液化、坏死,与周围组织分离。镜下肿瘤细胞坏死率大多达90%以上。全组中位生存期365个月,局部复发率20%。结论　皮下埋植式动脉化疗,操作简便、安全、毒副反应小,达到了维持肿瘤内药物浓度高,有效杀灭瘤细胞的目的,为保肢疗法提供一个更安全的切除缘。肿瘤细胞坏死率对判定疗效、评估预后、指导术后化疗有重要价值。Objective To evaluate the effect of subdermal implantable intraaterial chemotherapy combined with limb preserring eperation treatment for bone sarcoma.Methods 15 patients with bone sarcoma were collected into a prospective study.There were 10 males and 5 females.The sites of tumor were femur distally (14 cases) and proximally fibula(1 case);12 patients were with stge Ⅱ B,and 3 patients with stage Ⅲ A.ALL the patients were treated by intraatarial chemotherapy 6 times before operation,marginal or wide resection were perfermed; intraatarial chemotherapy was given 4 times after opration.Results After intraatarial chemotherapy,the symptoms of the patients were Losing,X ray or CT showed that tumor was reduced in size or sclerosed,periosteal new bone formed with regular rim.It was seen that tumor was separated with soft tissues during the operation.Histologic studies showed that the rate of tumor cell necrosis was over 90% in the most patiehts.The median servival period was 36.5 months and the local recurrence rate was 20%.Conclusions Subdermal implantable intraaterial chemotherapy is simple,effective and ensures marginal excison for osteosarcoma to be performed.The rate of histologic necrosis is one of the significant indexes for assessing the treatment and prognosis of patients.

关 键 词：骨肿瘤 骨肉瘤 综合化疗 动脉置管 保肢术 治疗 

分 类 号：R738.1[医药卫生—肿瘤]