骨盆肿瘤性骨软化症的精准手术治疗:单中心回顾性研究  

Precise surgical treatment of tumor⁃induced osteomalacia in pelvis:a single center retrospective study

作　　者：徐启明 崔丽嘉 徐海荣[1] 李远[1] 单华超[1] 董荣芳[3] 黄真[1] 马珂[1] 夏维波[2] 牛晓辉[1] XU Qi-ming;CUI Li-jia;XU Hai-rong;LI Yuan;SHAN Hua-chao;DONG Rong-fang;HUANG Zhen;MA Ke;XIA Wei-bo;NIU Xiao-hui(Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Beijing 100085, China;Department of Endocrinology,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences& Peking Union Medical College,Beijing 100730, China;Department of Pathology, Beijing Jishuitan Hospital, Beijing 100085, China)

机构地区：[1]北京积水潭医院骨肿瘤科,北京100085 [2]中国医学科学院北京协和医学院北京协和医院内分泌科,北京100730 [3]北京积水潭医院病理科,北京100085

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2022年第2期152-158,共7页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：北京积水潭医院院级科研基金(ZR-201903);国家自然科学基金(82100946);白求恩·石药骨质疏松科研基金(G-X-2020-1107-16);中国医学科学院中央级公益性科研院所基本科研业务费(2017PT32020,2018PT32001)。

摘　　要：目的 探讨精准、完整切除骨盆肿瘤性骨软化症(tumor-induced osteomalacia,TIO)复杂病灶的方法经验。方法 回顾性分析2018年1月至2021年3月就诊于北京积水潭医院骨肿瘤科骨盆TIO患者的基本信息、术前血磷、病灶定位、手术方式、术后转归等指标。结果 共纳入4例TIO患者,病灶均定位于骨盆。中位诊断年龄为48(37~65)岁,中位术前血磷为0.39(0.33~0.47)mmol/L。4例TIO患者术前均应用奥曲肽SPECT/CT或^(68)Ga-DOTATATE-PET/CT、^(18)F-FDG-PET/CT联合解剖影像学手段定位肿瘤病灶。采用病灶刮除术2例,整块切除术2例。4例患者中应用术中计算机导航技术3例,术后获得病情缓解2例。结论 骨盆TIO手术难度大,术前对病灶的精准定位,术中导航技术的运用及病灶的完整切除,可能有助于骨盆TIO的精准手术治疗,但仍无法解决骨盆TIO手术未缓解率高的难题。Objective To investigate the strategies for resecting complex tumors precisely and completely in patients with pelvic tumor-induced osteomalacia(TIO).Methods This study retrospectively analyzed pelvic TIO patients in Department of Orthopedic Oncology,Beijing Jishuitan Hospital,from January 2018 to March 2021.Demographic information,preoperative serum phosphate,tumor localization,surgery method,and surgery outcome were collected.ResultsFour pelvic TIO cases were recruited for the analysis.The median diagnostic age was 48(37-65)years,and the median preoperative serum phosphate was 0.39(0.33-0.47)mmol/L.Four TIO patients took octreotide SPECT/CT,^(68)Ga-DOTATATE-PET/CT or ^(18)F-FDG-PET/CT,combined with anatomic imaging techniques,for preoperative localization of the tumor.Two patients took curettage and the other two patients took en-bloc resection.Three of four patients took computer-assisted navigation intraoperatively,and two patients had complete remission after surgery.Conclusions The surgery of TIO in pelvis is challenging.Precise tumor localization preoperatively,application of intraoperative computer-assisted navigation,and complete resection of the tumor,may help improving the precise surgery of pelvic TIO.Yet,the problem of high non-remission rate of pelvic TIO surgery is still not solved.

关 键 词：肿瘤性骨软化症 骨盆 计算机辅助导航 病灶刮除术 整块切除术 

分 类 号：R681[医药卫生—骨科学]