唑来膦酸可能有助于抑制脊柱骨巨细胞瘤术中出血及预防术后复发  

Zoledronic acid may prevent intra-operative bleeding and recurrence of spinal giant cell tumor

作　　者：郑伟[1,2] 吴娟[3] 胡晓媛[4] 肖建如[2] 

机构地区：[1]成都军区总医院骨科,成都610083 [2]第二军医大学长征医院骨科,上海200003 [3]成都军区总医院药剂科,成都610083 [4]第二军医大学训练部,上海200433

出　　处：《第二军医大学学报》2013年第9期990-993,共4页Academic Journal of Second Military Medical University

基　　金：成都军区总医院院管课题(2013YG-B041)~~

摘　　要：目的探讨唑来膦酸对脊柱骨巨细胞瘤术中出血及术后复发的可能影响。方法采用前瞻性、临床观察性对照研究。唑来膦酸组:患者于术前1周使用唑来膦酸4mg,术后3周再使用唑来膦酸4mg,此后每4周使用唑来膦酸4mg,直至术后3年或患者不能耐受。对照组:患者在术前与术后均不使用唑来膦酸及二膦酸盐类药物。记录所有患者术中出血量。患者术后每6个月进行一次影像学随访,以明确是否复发。结果共53例符合条件的患者入选本研究,唑来膦酸组28例,对照组25例。唑来膦酸组患者术中平均出血量为(1 594±847)mL(400～3 200mL),对照组为(2 476±769)mL(800～4 000mL),差异有统计学意义(P<0.05)。唑来膦酸组患者3年内无复发,且无一例出现严重不良反应;对照组4例出现局部复发(2例在术后24个月时,2例在术后36个月时)。对照组患者3年复发率(16%)高于唑来膦酸组,差异有统计学意义(χ2=4.846,P=0.028)。结论术前辅助使用唑来膦酸可能有利于抑制脊柱骨巨细胞瘤术中出血,术后长期应用唑来膦酸可能有助于预防肿瘤复发,相关结论仍有待大样本随机对照研究证实。Objective To evaluate the possible influence of zoledronic acid on intra-operative bleeding and recurrence of spinal giant cell tumor. Methods A prospective, observational clinical control study was conducted. The zoledronic acid group： patients received zoledronie acid 1 week before （4 rag） and 3 weeks after （4 mg） the surgery; after then 4 mg zoledronic acid was given every 4 weeks for 3 years after surgery or till the patients could not tolerate. The control group： patients received no zoledronic acid or bisphosphonate before and after operation. The intraoperative blood loss was recorded for all the patients and the patients were given an imaging follow-up every 6 months postoperatively to detect recurrence. Results A total of 53 patients were eligible for this study, including 28 for zoledronic acid group and 25 for control group. The average amount of bleeding was （1 594±847） mL （400-3 200 mL） for zoledronic acid group and （2 476±769） mL （800-4 000 mL） for the control group, showing significant difference between the two groups （P〈 0. 05）. No patients in the zoledronie acid group had recurrence or severe adverse reactions within 3 years after surgery. Four patients （16%） in the control group had local recurrence within 3 years after surgery （2 patients occurred after 24 months, 2 patients occurred after 36 months）. The Chi- square tests result showed significant difference in recurrence rates between the two groups （2χ = 4. 846, P = 0. 028）.Conclusion Preoperative use of zoledronic acid can effectively inhibit the bleeding during the operation for spinal giant cell tumor, and long-term postoperative use of zoledronic acid can help to prevent recurrence, which needs large sample study for further verification.

关 键 词：骨巨细胞瘤 脊柱 唑来膦酸 术中出血 复发 

分 类 号：R738.1[医药卫生—肿瘤]