Surgical treatment of bone tumors of pelvic ring region
- Author:
- No author available
- Journal Title:
- JOURNAL OF THE FOURTH MILITARY MEDICAL UNIVERSITY
- Issue:
- 12
- DOI:
- 10.3321/j.issn:1000-2790.1999.12.002
- Key Word:
- 骨盆/外科学;骨肿瘤;微波;半骨盆切除;局部刮切;化疗
Abstract： 目的:评价半骨盆截除术、内半骨盆切除体外灭活再植或单纯旷置术、插入式微波天线阵列诱导高温原位灭活术治疗骨盆部骨肿瘤;部分切除术及前后联合入路局部刮除并辅助以局部单纯放疗或(和)置管持续灌注化疗术治疗骶骨肿瘤的效果.探讨骨盆环区域骨肿瘤的各种外科治疗方法的优缺点,以便更有效地治疗该部位肿瘤.方法:7 a中外科治疗骨盆环区域各类良、恶性骨肿瘤146例,其中应用半骨盆截除术治疗晚期骨盆骨肿瘤44例;内半骨盆切除体外灭活再植或单纯旷置术治疗骨盆部骨肿瘤10例;插入式微波天线阵列诱导高温原位灭活术治疗骨盆部骨肿瘤42例;部分切除术及前后联合入路局部刮除术后局部单纯放疗或(和)置管持续灌注化疗术治疗各类骶骨肿瘤50例.平均随访3 a以上,从肿瘤学、肢体关节功能学、并发症等方面综合评价上述各种外科治疗方法的优、缺点.结果:44例半骨盆截除患者仅存活16例.仅有少数年轻患者术后可佩带假肢行走,但步态极差;内半骨盆截除后体外灭活再植或旷置术10例患者中,复发1例;死亡2例;感染3例;肢体关节功能优良率为40%.应用插入式微波天线阵列诱导高温原位灭活治疗骨盆骨肿瘤42例;8例局部复发,其中5例死亡.其余34例中肢体关节功能25例为优,9例尚可.2例感染,1例坐骨神经热损伤.部分切除术及前后联合入路局部刮除术、局部单纯放疗或(和)置管持续灌注化疗术治疗各类骶骨肿瘤50例,死亡9例,复发2例,其余39例均得良好局部控制而治愈,治愈率为78%;39例中32例为高位骶骨肿瘤(肿瘤侵犯的最高平面均达骶2,甚至达腰5平面)采用前后联合入路,肿瘤局部刮除,辅以局部放疗或(和)置管持续灌注化疗治疗者,仅1例复发,复发率仅为3.1%(1/32).结论:骨盆环区域骨肿瘤由于解剖复杂等原因,其外科治疗仍存在许多疑难问题.除去一些甚晚期的患者仍需做半骨盆截除(下四分之一截肢术)外,插入式微波天线阵列诱导高温原位灭活治疗骨盆部骨肿瘤;前后联合入路、局部刮除后局部放疗或(和)置管持续灌注化疗治疗高位骶骨肿瘤是骨盆环区域骨肿瘤安全有效、有实用价值的外科治疗方法.
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