73例四肢转移性骨肿瘤的疗效观察  

Clinical analysis and observation of 73 cases with limb metastatic bone tumor

作　　者：董扬[1] 桑尚 张智长[1] 嵇伟平[1] Dong Yang;Sang Shang;Zhang Zhichang;Ji Weiping(Department of Orthopedics,the Sixth People＇s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华老年骨科与康复电子杂志》2018年第5期282-286,共5页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：2016上海市自然科学基金(16ZR1425500)

摘　　要：目的探讨四肢转移性骨肿瘤的诊断、治疗与预防的方法。方法前瞻性收集2010年1月至2015年12月四肢转移性骨肿瘤73例,年龄23～83岁,平均(56±8)岁。男性31例,女性42例,病理性骨折11例。其中肺癌转移20例,乳腺癌转移15例,肾癌转移15例,甲状腺癌转移10例,肝癌转移9例、结肠癌转移1例,子宫平滑肌肉瘤转移1例,直肠平滑肌肉瘤转移1例,胰腺癌转移1例。20例拒绝手术,选择保守治疗,另53例行手术治疗。手术方式包括瘤段切除假体置换术,病灶刮除植骨术,截肢术等。随访患者术后肢体功能情况、疼痛减轻情况、生存率等。结果随访时间6～72个月,平均(26±19)个月。53例手术患者术后骨痛均明显减轻,肢体功能恢复均良好。20例保守治疗患者肢体功能较差,患肢疼痛较重。结论骨转移性肿瘤的诊断应根据患者的年龄、主诉、影像学表现和病理检查进行综合判断,在治疗方法上,应首先评估患者有无手术指征,建议使用KPS标准,进而选择手术治疗或是保守治疗。对转移性骨肿瘤,应以减轻患者痛苦、恢复患肢功能,提高生活质量为目的。病理性骨折的预防尤为重要,一旦发生骨折,则增加痛苦,影响生活质量。Objective To study the diagnosis, treatment and prevention of the pathologic fracture caused by metastatic bone tumors. Methods A series of 73 patients with metastatic bone tumors were prospectively analyzed from January 2010 to December 2015, and aged from 23 to 83 years old, with an average of （56±8） years old. There were 31 males and 42 females, 11 cases were pathological fractures. 20 cases refused surgery and stay with conservative treatment, other 53 cases received surgical treatment, including 20 lung cancer metastasis, 15 cases breast cancer metastasis, 15 renal carcinoma metastasis, 10 thyroid cancer metastasis, 9 hepatoma metastasis, 1 rectal carcinoma, 1 rectal leiomyosarcoma, 1 uterineleiomyosarcoma and 1 pancreatic carcinoma. 20 patients refused surgery and chosen conservative treatment. Another 53 cases were treated surgically. Surgical methods were tumor resection, prosthesis replacement, tumor curettage and bone grafting, amputation and so on. Limb function, pain relief and survival rate of all patients were followed-up. Results All cases were well followed-up for 6 to 72 months, with an average of （26.46±19.12） months. The postoperative bone pain of 53 patients was obviously reduced and the recovery of limb function were good. 20 cases of conservative treatment had poor limb function and severe limb pain. Conclusions The diagnosis of metastatic bone tumors should be based on patient＇s age, chief complaints, imaging findings and pathological examinations. For the treatment method, patients should be assessed first whether or not there is an indication for surgery. KPS criteria is recommended to select surgical treatment or conservative treatment. The aim of metastatic bone tumor therapy is to reduce the suffering, restore the body functions and improve the quality of life. Prevention of pathological fractures is particularly important, once occurs can cause great pain and affect the quality of life.

关 键 词：骨肿瘤 肿瘤转移 治疗 

分 类 号：R738.1[医药卫生—肿瘤]