影像引导下经皮微波消融治疗骨转移癌性疼痛  

Image-guided percutaneous microwave ablation in the treatment of cancerous pain for patients with bone metastases

作　　者：柯晋[1] 张余[1] 陈旭琼[1] 陈玲玲 姚孟宇 KE Jin;ZHANG Yu;CHEN Xuqiong;CHEN Lingling;YAO Mengyu(Department of bone and joint surgery,Guangdong Key Laboratory of Orthopaedic Technology and Implant Materials,Guangzhou General Hospital of Guangzhou Military Command,Guangzhou,Guangdong 510010,China)

机构地区：[1]广州军区广州总医院骨病关节科广东省骨科矫形技术及植入材料重点实验室,510010

出　　处：《中国骨科临床与基础研究杂志》2017年第6期365-369,共5页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：国家自然科学基金项目(31771038)

摘　　要：目的探讨影像引导下经皮微波消融治疗骨转移癌性疼痛的手术方法,评估其有效性和安全性。方法对2015年1月至2017年7月在广州军区广州总医院接受影像引导下经皮微波消融手术的8例骨转移癌患者的临床资料进行回顾性分析。其中男6例,女2例,年龄53~74岁(平均61岁);原发肿瘤为肺癌4例、肝癌3例、纤维肉瘤1例,均经影像学及病理学结果明确诊断。根据视觉模拟量表(VAS)疼痛评分标准记录患者术前、术后1 d、7 d、1个月的疼痛程度,采用美国骨肿瘤学会(MSTS)评分对患者术后2周的功能改善情况进行评估。结果住院时间2~4 d(平均3 d),平均随访时间5.4个月(3~12)个月。患者术后VAS疼痛评分明显下降,MSTS功能评分明显增加(P<0.05)。1例患者术中因恶心不适提前中止治疗;1例术后2周出现手术部位伤口感染;4例复发,复发率4/8;死亡3例,总体1年生存率5/8。结论影像引导下经皮微波消融治疗骨转移癌性疼痛,近期效果显著,同时还具有术式安全、操作简便、功能改善明显等优势。Objective To explore the surgical method of image-guided percutaneous microwave ablation in the treatment of cancerous pain for patients with bone metastases,and to evaluate its safety and efficiency.Methods Clinical data of 8 patients with bone metastases who underwent image-guided percutaneous microwave ablation in Guangzhou General Hospital of Guangzhou Military Command from January 2015 to July 2017,were retrospectively analyzed.Among them,there were 6 males and 2 females,with average age of 61 years old(range 53 to 74 years old),including primary lung cancer in 4 patients,primary liver cancer in 3 and primary fibrosarcoma in 1 patient,whose diagnoses were all determined by radiological and pathological results.According to visual analogue scale(VAS)pain scoring,patients'pain was recorded preoperatively and 1 d,7 d and 1 month postoperatively.The improvement of function at 2 weeks after the surgery was evaluated by American Musculoskeletal Tumor Society(MSTS)score.Results The average hospital stay was 3 d(2 to 4 d),and the average follow-up was 5.4 months(3 to 12 months).Compared to preoperative ones,postoperative VAS pain score and MSTS functional score all improved significantly(P<0.05).Treatment for 1 case was withdrawn due to intraoperative nausea,and surgical site infection occurred in 1 case at 2 weeks after the operation.The local recurrence rate was 4/8 and one-year overall survival was 5/8.Conclusion For patients with bone metastasis who suffered from cancerous pain,image-guided percutaneous microwave ablation appears to be effective in short term,with the advantages of providing safe approach,simple procedure and functional improvement.

关 键 词：骨肿瘤 肿瘤转移 疼痛 微波 导管消融术 超声检查 体层摄影术 X线计算机 

分 类 号：R738[医药卫生—肿瘤]