晚期骨肉瘤术后复发三例报道并文献复习  

The postoperative recurrence of advanced osteosarcoma:3 cases report with a review of literature

作　　者：于秀淳[1] 吴苏稼[2] 王序全[3] 许宋锋[1] 徐明[1] 袁冶[1] 

机构地区：[1]济南军区总医院骨病科,济南250031 [2]南京军区总医院骨科,南京210002 [3]第三军医大学西南医院骨科,重庆400038

出　　处：《中国骨与关节杂志》2013年第9期490-494,共5页Chinese Journal of Bone and Joint

摘　　要：目的探讨晚期骨肉瘤术后复发的临床特点与治疗方案。方法回顾分析我们所治疗的3例晚期骨肉瘤术后复发病例，结合文献检索到的10例晚期复发骨肉瘤病例，共13例。13例中，男8例，女5例。复发时年龄13～42岁，平均25.56岁。部位：股骨远端5例，胫骨远端和髋臼各2例，胫骨近端1例（其余未描述）。组织学类型：纤维母细胞型3例，传统型2例，混合型2例，骨母细胞型、软骨母细胞型、毛细血管扩张型各1例，其余未描述。复发时间5.2～19.3年，平均10.02年。治疗方式：手术＋化疗5例，手术＋放疗1例，手术2例，1例放弃治疗（其余未描述）。结果本组除1例未记录随访外，余12例随访6个月至4.7年，平均2.28年。存活6例（最长4.5年），死亡6例（0.6～4.7年）。结论晚期骨肉瘤术后复发患者的临床表现、发病部位、组织学类型等无明显特异性。临床要重视骨肉瘤患者的远期定期随访，术后5年应该每半年随访1次，在重视排除患者肺部及其他部位转移的同时，更应该重视手术部位的异常变化。一旦明确为晚期术后复发，手术和化疗是目前临床常用的治疗方法。临床疗效有待进一步观察。Objective To investigate the clinical characteristics and treatment options of the postoperative recurrence of advanced osteosarcoma. Methods The data of 3 patients with postoperative recurrence of advanced osteosarcoma treated in our hospital were analyzed retrospectively, combined with 10 cases of late recurrent osteosarcoma in literature retrieval. There were 8 males and 5 females. The mean age at the moment of recurrence was 25.56 years old （ range;13-42 years ）. Locations：5 cases occurred in the distal femur, 2 cases in the distal tibia and acetabulum respectively and 1 case in the proximal tibia, and the rest cases were not described. Histological types：3 cases of ifbroblastic type, 2 cases of traditional type, 2 cases of mixed type, 1 case of osteoblastic type, 1 case of chondroblastic type and 1 case of telangiectasia type, and the rest cases were not described. Recurrent period：an average period of 10.02 years （ range;5.2-19.3 years ）. Treatment modalities：5 patients accepted operation and chemotherapy, 1 patient with operation and radiotherapy, 2 patients with operation and 1 patient gave up therapy, and the rest cases were not described. Results 12 cases were followed up for an average period of 2.28 years （ range;6 months-4.7 years ）, except that 1 case was lost in this group. 6 patients survived （ up to 4.5 years ）, and 6 patients died （ 0.6-4.7 years ）. Conclusions No signiifcant speciifcity is found in the clinical characteristics, lesion locations, histologic types and so on in the patients with postoperative recurrence of advanced osteosarcoma. The long-term and regular follow-up in the patients with osteosarcoma should be valued clinically. It is necessary to follow up once every 6 months 5 years after the operation. The abnormal changes in the surgical site should be given more attention at the same time that the exclusion of pulmonary and other metastases is focused on. Once the diagnosis of late postoperative recurrence is conifrmed, operation and chemotherapy are

关 键 词：骨肉瘤 治疗 预后 晚期复发 

分 类 号：R738.1[医药卫生—肿瘤]