手术联合体外放疗治疗复发性色素绒毛结节性滑膜炎的初步探讨

The preliminary investigation of operation in conjunction with adjuvant postoperative radiation therapy in the treatment of recurrent pigmented villonodular synovitis

目的 探讨手术联合体外放疗在复发性色素绒毛结节性滑膜炎 (PVS)治疗中的应用及临床意义。方法 对 1 998年 4月至 2 0 0 3年 4月收治的 1 0例手术后复发的色素绒毛结节性滑膜炎患者再行手术切除 ;术后 3～ 4周起 ,依据术中病灶范围及切除情况设野行体外放疗 ,用直线加速器 6MV -X射线 ,DT2 0 0cGy/次 ,1次 /天 ,给平均总剂量DT45 5 0cGy/5W(3 60 0cGy～ 5 60 0cGy)。结果 本组随访 1 3个月～ 5年5个月 ,所有病人局部病变无复发。一例左肘关节DPVS伴关节不稳 ,但不影响日常生活 ;一例患膝关节活动受限 (关节活动度 0°～ 95°) ;一例踝关节内外翻及内外旋轻度受限。放疗期间相关并发症有 :关节周围肿胀 ,轻度放射性皮炎 ,远期主要为射野皮肤色素沉着 ,无放射性骨、关节或神经血管损伤。结论 PVS是一组复发率较高的具有侵袭性行为的良性滑膜病变 ,对复发病例给予积极手术切除 ,术后联合辅助体外放射治疗可以减少和预防术后局部复发。

Objective To investigate therapeutic effect of operation in conjunction with adjuvant postoperative radiation therapy in the treatment of recurrent pigmented villonodular synovitis.Methods From April 1998 to April 2003, 10 cases of recurrent PVS were treated by open synovectomy and adjuvant postoperative radiation therapy. Adjuvant radiation was performed 3-4 weeks postoperatively; the dose of radiation was 4550cGy/5W ( 3600- 5600cGy).Results The mean follow-up time was 38 months (13-65 months). All patients were followed by taking repeated computerized tomography scans and plain X-ray films and no local recurrence was found; 1 patient lost the stabilization of his cubital articulation; 1 patient lost some degree of knee motion (0°～95°). In 8 patients, no complications were noticed after surgery or after the radiation therapy. There was no evidence of disease and progression of bone or articular destruction found in all patients.Conclusion Pigmented villonodular synovitis is a difficult tumor to eradicate. A combination of open synovectomy with external beam radiation for recurrent pigmented villonodular synovitis is a reliable method of treatment with good results.