肢体肿瘤保肢手术的几个问题(附274例报告)  

Several questions about extremity retention operation of limb tumor

作　　者：陶天遵[1] 陶树青[1] 郝克强[2] 曲国蕃[2] 李永彬 王玉华 

机构地区：[1]哈尔滨医科大学附属第二医院骨科,黑龙江哈尔滨150086 [2]哈尔滨医科大学附属第三医院骨科,黑龙江哈尔滨150040

出　　处：《哈尔滨医科大学学报》2000年第6期418-421,共4页Journal of Harbin Medical University

摘　　要：目的　探讨肢体恶性肿瘤保肢手术的价值、适应证选择、手术操作原则、肿瘤局部复发与再手术、手术并发症、化疗的重要性、骨转移瘤的保肢手术、人工假体置入在保肢手术中的应用等问题。方法　对 2 74例肢体恶性肿瘤保肢手术的临床资料进行分析、讨论。结果　随访 6～ 15 6个月 ,平均随访 49 6个月 ,5年生存率为 31% ,肿瘤局部复发率为 5 % ,术后功能优良率为 6 3%。结论　保肢手术应作为四肢恶性肿瘤外科治疗的首选方法 ,术前后以大剂量MTX加四氢叶酸解救方案为主的系统化疗是提高 5年生存率 ,减少局部复发的关键因素之一 ,严格的选择保肢手术适应证 ,遵循边缘完整的切除肿瘤的原则是手术成功的前提条件 ,人工假体置入是保肢手术中肢体瘤段缺损修复、重建的较好方法 ,提高人工假体的设计与制造水平 ,提高手术技巧 ,将减少术后并发症的发生。Objective To discuss the questions about the value of extremity retention operation of malignant tumor,the choice of indication,the principle of operation,carcinoma local relapse and re operation,the operational complication,the importance of chemotherathy,bone metastatic carcinoma operation for extremity retention,the use of artificial body.Methods The clinic documents of 274 patients with extremity malignant tumor treated by extremity retention operation were analysed,and the relative question were discussed.Results Follow up 6～156 months,average 49.6 months,5 years survival rate was 31%,local relapse rate was 5%,post operational excellent rate was 63%.Conclusion The operation of extremity retention should be the first choice to treat the limb malignant tumor.The chemotherathy with large dose MTX and tetrahydrofolic acid is one of the key factors to improve 5 years survival rate,and abiding by the principle to choose operational principle to choose operational indication strictly and total cancer removal is the precondition of operation success.The displacement of artificial body is one good method for defect part repairation.It will reduce the postoperational complication to improve the level of artificial body design and the operational skill.

关 键 词：肢体肿瘤 保肢手术 人工假体 

分 类 号：R739.96[医药卫生—肿瘤] R730.56[医药卫生—临床医学]