四肢骨肉瘤手术治疗方式选择与预后  

Selection of Operation Treatment Method and Prognostic Analysis of Osteosarcoma of Limbs

作　　者：刘雪峰[1,2] 杨祚璋[1,2] 李懿[3] 张娅[1,2] 张晶[1,2] 王少云[1,2] 杨义豪[1,2] 张曌昕 

机构地区：[1]昆明医科大学第三附属医院 [2]云南省肿瘤医院骨与软组织肿瘤研究中心,云南昆明650118 [3]成都军区昆明总医院肿瘤科,云南昆明650032 [4]昆明医科大学,云南昆明650500

出　　处：《昆明医科大学学报》2015年第6期46-50,共5页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(81201756;81460440;81260322;81372322)

摘　　要：目的探讨四肢骨肉瘤患者不同手术方法的临床疗效及预后.方法回顾性分析2010年5月至2012年10月在昆明医科大学第三附属医院及成都军区昆明总医院接受手术治疗的骨肉瘤患者68例,根据手术方式分为:截肢组20例,瘤骨骨壳灭活再植术组12例,大段异体骨关节移植组10例及瘤段切除+人工假体置换术组26例.观察4组患者术后局部复发率、肺转移率以及远期生存率并进行统计分析.结果四肢骨肉瘤截肢术在局部复发率方面均低于瘤骨骨壳灭活再植术、大段异体骨关节移植术及瘤段切除+人工关节假体置换术(P<0.05),但是在远期生存率以及肺转移率方面4种手术方式差异无统计学意义(P>0.05).结论截肢术是一种致残性手术方式,多数患者不能够接受.瘤骨骨壳灭活再植术、大段异体骨关节移植术及瘤段切除+人工关节假体置换术这3种手术方式有利于保存肢体功能,但手术方式的选择,应当根据患者的个体化情况综合分析选择最优化的手术方案,手术过程中如何降低手术并发症的发生率,提高手术质量以及患者的术后生活质量,有着非常重要的意义.Objective The study aimed to investigate the clinical efficacy and prognosis of different surgical methods for patients with osteosarcoma in limbs. Methods A retrospective analysis was made on clinical data of 68 patients with osteosarcoma underwent surgery in the Third Affiliated Hospital of Kunming Medical University and Kunming General Hospital of Chengdu Military Area Command of Chinese PLA from May 2010 to October 2012.According to the operation methods, patients were divided into： amputation group 20 cases, tumor bone shell inactivated bone replantation group 12 cases, massive bone allograft group 10 cases and tumor segmental resection and prosthetic replacement group 26 cases. The local recurrence rates, pulmonary metastatic rates and long- term survival rates of four groups were observed and analyzed statistically after operation. Results The local recurrence rate of amputation for osteosarcoma in limbs was lower than that of the tumor bone shell inactivated bone replantation,allografts bone joint transplantation and tumor section removal and artificial joint prosthetic replacement（P〈0.05）,but there were no significant differences in the long- term survival rate and lung metastasis rate among four kinds ofsurgical methods（P〉0.05）. Conclusion Amputation is a disabling operation mode, so most patients are unable to accept. The surgical methods of tumor bone shell inactivated bone replantation,allografts bone joint transplantation and tumor section removal and artificial joint prosthetic replacement are conducive to the preservation of limb function, but the choice of surgical method should be based on the comprehensive analysis of individual patient to choose the operation scheme optimization. It is very important to reduce the operation complications and the incidence rate of operation and improve the surgical quality and the patient＇s postoperative quality of life.

关 键 词：骨肉瘤 手术治疗 临床疗效 

分 类 号：R738.1[医药卫生—肿瘤]