肺癌伴股骨转移的外科治疗

Surgical management of lung cancer metastasis in the femur

目的探讨肺癌伴股骨转移患者外科治疗的疗效和意义。方法回顾性分析南京大学医学院附属鼓楼医院2005—2014年间手术治疗的股骨转移癌患者19例,其中股骨远端2例、股骨干6例、粗隆下5例、粗隆间3例、股骨颈4例(1例双肢转移)。对其预期生存时间及实际生存时间进行评估与对比;濒临骨折患者术前进行Mirels评分;术前术后进行疼痛评分;术后分别于3、6、12个月和最后随访时间采用Enneking评分标准对患者进行术后功能评估。结果平均随访时间为11个月(3~24个月),全组患者均死亡,最长时间24个月。中位生存时间为9个月(3~24个月)。实际生存时间大于预期生存时间[(11.9±12.2)、(3.9±2.8)个月(P=0.000)]。濒临骨折的术前疼痛评分为(4.1±2.3)分,术后疼痛评分为(1.9±0.9)分(P=0.000)。术后3、6、12个月和末次随访时间的Enneking功能评分为12~24分。结论根据股骨是否存在病理性骨折、濒临骨折、病灶部位、累及范围选择手术治疗方法。作为综合治疗的手段之一,可有效地缓解疼痛,改善肢体功能,提高生存质量。

Objective To investigate the efficacy and significance of surgical management of lung cancer metastasis in the femur.Methods A retrospective analysis was made of 19 cases of metastatic cancer of the femur treated by operation in Gulou Hospital Affiliated to Nanjing University Medical College from 2005 to 2014,including 2 cases of distal femur,6 cases of femoral shaft,5 cases of inferior trochanter,3 cases of intertrochanter and 4 cases of femoral neck(1 case of double limb metastasis).To evaluate and compare the expected survival time and actual survival time;to evaluate the function of the patients before and after the operation with mirels score;to evaluate the pain score before and after the operation with Enneking score standard at 3,6,12 months and the last follow-up time.Results The average follow-up was 11 months(3-24 months).All patients deceased.The median survival was 9 months(3-24 months).The actual survival time was longer than the expecting survival time((11.9±12.2)months,(3.9±2.8)months,P=0.000).The preoperative pain score was(4.1±2.3),and the postoperative pain score was(1.9±0.9)(P=0.000).The Enneking function score was 12-24 at 3,6,12 months and the last follow-up time.Conclusions The surgical management should be referred to the complete fracture,impending fracture,location,extent of involvement of the lesion in the femur.As one of the systemic managements of metastasis,surgical management of metastasis in the femur played an important role in the relief of pain,improvement of the functional level and the quality of life.