射频消融在骨转移癌姑息治疗中的应用  

A application of radiofrequency ablation in the palliative treatment of bone metastases

作　　者：鱼锋[1] 张清[1] 赵海涛[1] 徐立辉[1] 牛晓辉[1] 

机构地区：[1]北京积水潭医院骨肿瘤科,100035

出　　处：《中国骨与关节杂志》2014年第4期268-271,共4页Chinese Journal of Bone and Joint

摘　　要：目的：探讨射频消融在骨转移癌治疗中的安全性和有效性。方法2008年11月至2012年12月，我科应用射频消融治疗骨转移癌19例，男10例、女9例，平均年龄57（41～76）岁，原发病灶分别是：肺癌11例，肾癌2例，乳腺癌、甲状腺癌、直肠癌、胃癌、肝癌各1例，原发不明1例。19例共消融21处病灶，病灶分别位于股骨（9处）、骨盆（6处）、肱骨（5处）、胫骨（1处）。手术方法：16处病灶行射频消融后肿瘤刮除，重建骨连续性；另外5处病灶只行经皮射频消融，其中3处股骨干病灶行髓内针固定。术后进行随访，并用疼痛评分及功能评分进行疗效评价、检查有无复发及手术的安全性。评价方法：（1）术前和术后疼痛评分（数字分级法）对比；（2）长期（＞6个月）存活患者的功能评定（MSTS评分）。结果平均随访10（1～32）个月。死亡15例，平均存活9.7（1～32）个月，疼痛评分术前平均8.1分，术后1周平均2.2分，术后3个月平均2.7分，术前和术后比较，差异有统计学意义（P＜0.01）。对术后存活超过6个月的12例进行功能评定，优良率为83.3%。1例术后6个月消融处再次疼痛，口服止疼药物治疗，11个月后原发病进展死亡。1例术中在止血带处发生热损伤。1例术后皮缘坏死。结论射频消融治疗骨转移癌是一种安全有效的方法，对局部病灶可以缓解疼痛，控制肿瘤进展。Objective To investigate the safety and effectiveness of radiofrequency ablation （ RFA ） in the treatment of bone metastases. Methods From November 2008 to December 2012, 19 patients with bone metastases were treated with RFA in our department. There were 10 males and 9 females with an average age of 57 years old （ range;41-76 years ）. Lung carcinoma was the most common primary tumor （ n=11 ）, followed by kidney carcinoma （ n=2 ）, breast carcinoma （ n=1 ）, thyroid carcinoma （ n=1 ）, rectal carcinoma （ n=1 ）, gastric carcinoma （ n=1 ）, hepatocellular carcinoma （ n=1 ） and unknown carcinoma （ n=1 ）. There were totally 21 lesions in the 19 patients, including 9 lesions in the femur, 6 lesions in the pelvis, 5 lesions in the humerus and 1 lesion in the tibia. Curettage and reconstruction after the RFA were performed for 16 lesions. Percutaneous RFA was performed for 5 lesions, and 3 of them in the femoral shaft were ifxed with intramedullary nails. During the follow-up, the pain scores and function scores were used to evaluate the effects and check the recurrence and the safety of the surgery. There were 2 kinds of evaluation methods. （ 1 ） The preoperative and postoperative pain scores were compared （ numerical rating scale ）. （ 2 ） The function evaluation of the patients whose survival time was more than 6 months was performed （ the Musculoskeletal Tumor Society MSTS rating scale ）. Results The mean follow-up period was 10 months （range;1-32 months ） and the mean survival time was 9.7 months （ range;1-32 months ）. Fifteen patients were dead. The mean pain score was 8.1 points before the surgery and 2.2 points and 2.7 points at 1 week and 3 months after the surgery respectively, and there were statistically signiifcant differences before and after the surgery （ P＆lt;0.01 ）. Local pain recurred in 1 patient at 6 months after the ablation with the pain score of 7 points, who received oral analgesic but died 11 months later due to the progress of pri

关 键 词：导管消融术 骨肿瘤 肿瘤转移 微波 

分 类 号：R738.1[医药卫生—肿瘤]