骨肉瘤保肢综合治疗效果分析

Effects of operation combined with chemotherapy for osteogen ic sarcoma

目的 :探讨骨肉瘤保肢综合治疗的效果。方法 :回顾性分析 5 1例骨肉瘤综合治疗的临床资料。 3 2例患者分别行动脉区域灌注灭活和体内切刮灭活手术治疗 ,19例患者行截肢术。所有病例术前、术后均行化疗。结果 :保肢手术 3年和 5年生存率分别为 5 3 .1%和 3 7.5 % ,与同期截肢术相比无显著性差异 (P >0 .0 5 ) ;5年内的局部复发率为 6.2 5 % ;两种保肢术的 3年、5年生存率无显著性差异 (P >0 .0 5 )。结论 :在综合治疗模式下 ,保肢和截肢可获得相同的疗效。体内切刮灭活术具有简便、保留骨和关节原有形态及部分功能、并发症少、经济的优点。

Objective To explore the effects of operation com b ined with chemotherapy for osteogenic sarcoma. Methods A retro spective analysis was performed on 51 patients with osteogenic sarcoma treated by limb-preserving surgery or amputatio n. Thirty-two patients were treated by devitalization and replantation after lo cal arterial p erfusion or intrinsic resection and curettage with devitalization, 19 by amputa t ion. Chemotherapy was given for 6 cycles before and after operation. Res ults For devitalization and replantation after local arterial perfusion or intrinsic resecti on and curettage with devitalization, the average postoperative 3-,5-year survival rate was 53.1%, 37.5%, respectively in 32 patients with osteogenic sarc oma. Compared with the 19 patients who had amputation owing to osteogenic sarcom a in the same duration, there was no obvious difference of the postoperative 3 - ,5-years survive rate (P>0.05). And also no obvious difference of the 3- ,5 -year survival rates between the two kinds of limb preserving surgery (P>0. 05). The local recurrence rate was 6.25% of limb preserving surgery. Conclusion The long term results are the same in the treatment of osteogenic sarcoma by limb preserving surgery or amputation, and there are s o me advantages in intrinsic resection and curettage with devitalization, such as keep ing the original contour and continuity of bone and joint, retaining partial fu n ction of the injured joint, performing easily, less complications and less exp ense.