微波消融联合经皮骨成形术在椎外溶骨性转移瘤中的应用  

Application of microwave ablation combined with percutaneous osteoplasty in treating extraspinal osteolytic metastases

作　　者：王志龙 林文俐 杜贞华 张晓帆 梁逸宁 左太阳 WANG Zhilong;LIN Wenli;DU Zhenhua;ZHANG Xiaofan;LIANG Yining;ZUO Taiyang(Department of Oncology Intervention,Affiliated Central Hospital of Shandong First Medical University,Jinan,Shandong Province 250013,China)

机构地区：[1]山东第一医科大学附属中心医院肿瘤介入科,山东济南250013

出　　处：《介入放射学杂志》2023年第6期580-585,共6页Journal of Interventional Radiology

基　　金：山东省医药卫生科技发展计划(2019WS077);泉城“5150”引才倍增计划(创新人才)。

摘　　要：目的观察CT引导下微波消融(MWA)联合经皮骨成形术(POP)治疗椎体外溶骨性转移瘤的疗效与安全性。方法回顾性分析接受MWA联合POP治疗18例椎体外溶骨性转移瘤患者的临床资料。采用疼痛视觉模拟量表(visual analogue scale,VAS)、国际肌肉骨骼肿瘤学会(musculo-skeletal tumor society system,MSTS)评分、骨转移患者生活质量特异性量表(QLQ-BM22)评估患者手术前后疼痛程度、肢体功能状态和生活质量;记录手术成功率和术中、术后并发症情况,并对随访期间患者局部肿瘤控制状况和生存期进行统计分析。结果18例患者的MWA联合POP手术均成功。术中4例患者出现少量骨水泥渗漏,均无明显症状。手术前后VAS评分总体差异有统计学意义(F=41.74,P<0.01);术后各时间点VAS评分均低于术前(均P<0.01),而术后各时间点间差异均无统计学意义(均P>0.05)。手术前后MSTS评分总体差异有统计学意义(F=12.40,P<0.01);术后各时间点MSTS评分均高于术前(均P<0.01),而术后各时间点间差异均无统计学意义(均P>0.05)。手术前后QLQ-BM22评分总体差异有统计学意义(F=16.26,P<0.01);术后各时间点QLQ-BM22评分均低于术前(均P<0.01),而术后各时间点间差异均无统计学意义(均P>0.05)。术后随访3~28个月,生存时间为(9.14±7.94)个月。随访期间死亡7例,6例术后1年内死亡,1例术后26个月死亡。3例患者分别于术后8、15、16个月肿瘤复发,平均复发时间为13个月。结论CT引导下MWA联合经皮骨成形术治疗椎体外溶骨性转移瘤并发症少,安全可行,能有效缓解疼痛,改善患者肢体功能,提高患者运动能力和生活质量,术后局部肿瘤复发率低且复发周期较长。Objective To discuss the efficacy and safety of CT-guided microwave ablation(MWA)combined with percutaneous osteoplasty(POP)in treating extraspinal osteolytic metastases.Methods The clinical data of 18 patients with extraspinal osteolytic metastases,who received MWA combined with POP were retrospectively analyzed.The visual analogue scale(VAS)score,musculo-skeletal tumor society system(MSTS)score,and QLQ-BM22 score were used to evaluate the pain degree,limb function status,and quality of life before and after surgery.The surgical success rate,and the intraoperative and postoperative complications were recorded.The local control status of tumor and the survival time during follow-up period were statistically analyzed.Results Successful MWA combined with POP operation was accomplished in all the 18 patients.During the operation,slight bone cement leakage was observed in 4 patients with no obvious clinical symptoms.There was statistically significant difference in VAS score between preoperative value and postoperative value(F=41.74,P<0.01).The postoperative VAS scores determined at each time point were lower than preoperative one(all P<0.01),while no statistically significant difference in VAS score existed between different VAS values obtained at postoperative different time points(all P>0.05).There was statistically significant difference in MSTS score between preoperative value and postoperative value(F=12.40,P<0.01).The postoperative MSTS scores determined at each time point were higher than preoperative one(all P<0.01),while no statistically significant difference in MSTS score existed between different MSTS values obtained at postoperative different time points(all P>0.05).There was statistically significant difference in QLQ-BM22 score between preoperative value and postoperative value(F=16.26,P<0.01).The postoperative QLQ-BM22 scores determined at each time point were lower than preoperative one(all P<0.01),while no statistically significant difference in QLQ-BM22 score existed between the different QLQ-BM22

关 键 词：微波消融术 经皮骨成形术 椎体外溶骨性转移瘤 安全性 疗效 

分 类 号：R738.1[医药卫生—肿瘤]