原位微波消融术治疗骨肿瘤的常见并发症及防治策略  

PREVENTION AND CONTROL STRATEGIES OF COMMON POST-OPERATIVE COMPLICATIONS OF MICROWAVE ABLATION IN SITU IN TREATMENT OF BONE TUMORS

作　　者：杨小明[1] 张余[1] 张涛[1] 徐亮[1] 柯晋[1] 马立敏[1] 蓝国波[1] 姚子龙[1] 欧阳兰飞[1] 黄华扬[1] 夏虹[1] 尹庆水[1] 

机构地区：[1]广州军区广州总医院骨科医院骨病关节科,广州510010

出　　处：《中国修复重建外科杂志》2012年第12期1473-1476,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：全军医学科研"十二五"面上课题资助项目(CWS11C268);广东省科技计划课题资助项目(2007A060101003;2008A060101004)~~

摘　　要：目的探讨原位微波消融术治疗骨肿瘤的常见并发症发生原因及防治策略。方法 2009年3月-2012年7月,采用原位微波消融术治疗骨肿瘤73例,其中54例符合标准纳入研究。男31例,女23例;年龄9～74岁,中位年龄27岁。恶性肿瘤37例,良性肿瘤17例。49例原发骨肿瘤参照Enneking分期标准:3期17例,ⅡA期13例,ⅡB期19例。总结患者术后并发症发生情况、治疗方法及转归。结果术后54例均获随访,随访时间12～40个月,平均24个月。21例(38.9%)出现7项手术相关并发症,其中3例出现2项及以上并发症。其中病理性骨折4例(7.4%),深部感染2例(3.7%),神经损伤7例(13.0%),下肢深静脉血栓形成1例(1.9%),膝关节内侧副韧带热损伤1例(1.9%),切口血肿2例(3.7%),切口脂肪液化、皮缘坏死8例(14.8%)。结论病理性骨折是导致原位微波消融术后再次手术的首要并发症,深部感染是造成保肢失败的主要并发症,神经损伤及切口愈合不良是最常见并发症,对微波高温的控制是手术成功的关键,相应的预防措施可降低并发症的发生。Objective To analyze the common post-operative complications ot microwave amauon m snu in tnc treatment of bone tumors and the prevention and control strategies. Methods Between March 2009 and July 2012, 73 cases of bone tumors were treated with microwave ablation in situ, of which 54 cases met the inclusion criteria. There were 31 males and 23 females with a median age of 27 years （range, 9-74 years）, including 37 malignant tumors and 17 benign tumors. In 49 primary hone tumors, 17 cases were in stage 3, 13 in stage IIA, and 19 in stage IiB according to Enneking grading system. The postoperative complications, managements, and outcomes in patients were analyzed. Results After operation, 54 patients were followed up 12-40 months （mean, 24 months）. Seven kinds of complications occurred in 21 patients （38.9%） with 3 cases suffered from more than one, including pathologic fracture in 4 cases （7A%）, deep infection in 2 cases （3.7%）, nerve injury in 7 cases （13.0%）, deep vein thrombosis of the lower extremity in 1 case （1.9%）, medial collateral ligament heat injury of the knee in 1 case （1.9%）, hematoma in 2 cases （3.7%）, and fat liquefaction of incision and flap necrosis in 8 cases （14.8%）. Conclusion Pathologic fracture is the primary complication which results in a second surgery. Deep infection is the main complication that often leads to failure of the limb salvage. Nerve injury and poor wound healing are the most common complications. Good control of microwave temperature is the key to successful operation, and the related preventive strategies could reduce complications.

关 键 词：原位微波消融术 骨肿瘤 并发症 

分 类 号：R738.1[医药卫生—肿瘤]