摘要
目的 :探讨肢体骨肉瘤保肢手术结合新辅助化疗的临床疗效。方法 :对 1 3例四肢骨肉瘤患者进行保肢治疗 ,其中 1 1例进行了术前、后新辅助化疗。按 Enneking分期 ,IIA期 3例 ,IIB期 1 0例。施行人工关节置换术 5例 ,瘤段截除灭活再植术 8例。结果 :发生并发症 4例 ,其中皮肤坏死 1例、切口感染 3例。随访时间 3～ 2 9月 ,平均 1 4月。局部复发 2例 ,1例股骨骨肉瘤术后 1年出现复发 ,改行截肢术 ,1例胫骨近端骨肉瘤术前化疗效果不理想 ,保肢后出现复发。肺转移 1例 ,为术后未能坚持化疗者。 1例出现瘤骨灭活再植后骨不愈合。术后功能评定 ,优 4例 ,良 5例 ,可 2例 ,差 2例 ,优良率 69%。结论 :保肢手术结合新辅助化疗是治疗肢体骨肉瘤的比较理想的方法 ,有效的术前化疗是保肢成功的关键 ,坚持术后化疗是预防肺转移的有效措施。
Objective: To evaluate the clinical effectiveness of limb salvage surgery combined with adjuvant chemotherapy for patieats with osteosarcomas. Methods: Between Jan.2000 and Oct.2002,13 patieats of 12 to 45 years(average 20.3years) of age with the diagnosis of osteosarcomas of the extremities were treated with adjuvant chemotherapy and limb salvage surgery. The stages of tumors according to Enneking classification were IIA in 3,IIB in 10. Among them,endoprosthestic implantation was done in 5 patieats,simple tumor resection was performed in 8 patieats with fibula lesions. The histological evaluation of surgical margins revealed wide resection in 6 patieats and marginal resection in 7 patieats. Results: Major surgical complcations occurred in 4 cases. Skin necrosis in 1 cases and infection in 3 cases. The patieats were followed up for 3 to 29 months(average 14 months). Local recurrencein occurred in 2 cases,Lung metastasis occurred in 1 cases and nonunion 1 cases. The patieats were evaluated in regard to function with use of Enneking system.Among 13 cases,4 were classified as excellent results,5 cases good,2 cases fair,2 cases poor;an excellent or good result in 69% of the patieats. Conclusion: The limb salvage surgery combined with adjuvant chemotherapy is an ideal treatment methed for malignant bone tumor;an effective preoperative chemotherapy combined with extripative surgery make limbs salvage surgery successful;the postoperative chemotherapy is the only method to prevent lung metastssis.
出处
《陕西医学杂志》
CAS
北大核心
2004年第8期713-715,共3页
Shaanxi Medical Journal
