51例复发性骨巨细胞瘤的治疗

Treatment of 51 Cases of Recurrent Giant Cell Tumor of Bone

目的:探讨复发性骨巨细胞瘤(GCT)的治疗。方法:回顾51例四肢复发性GCT的临床资料,分析治疗效果。外科治疗依据病理和影像学分期,进行扩大的肿瘤刮除﹑辅助囊壁处理或肿瘤切除功能重建。结果:平均随访36个月,再复发8例,总复发率为15.7%,局部囊内刮除后再复发率为22.7%(5/22),肿瘤边缘切除后再复发率11.5%(3/26),手术并发症发生率为9.8%。结论:GCT复发后肿瘤局限且无明显软组织肿块,再次刮除空腔充填;有明显软组织肿块形成的CampanacciⅢ级和部分肿瘤较大的Ⅱ级患者,行瘤段切除后功能重建,选择性治疗可获得满意的疗效。

Objective： To explore the surgical treatment of recurrent giant cell tumor of bone （GCT）. Methods： A total of 51 cases of recurrent GCT in extremities that were seen during the period from January 1990 to December 2003 were reviewed. Twenly-two cases received extended curettage with adjuvant treatment of the capsule wall and functional reconstruction. Results： The mean follow-up was 36 months. Recurrence occurred for the second time in 8 cases and the overall rate of secondary local recurrence was 15.7%. The secondary recurrence rates after re-curettage and resection were 22.7% （5/22） and 11.5% （3/26）, respectively. Complications daring the surgical procedure accounted for 9.8% of the recurrent cases. Conclusion： Because of the self-limitation of these tumors, there is no overt lump that occurs with recurrence of GCT. New tumors are surgically removed again. Functional reconstruction after resection of the tumor can be conducted in the patients of Campanacci stage Ⅲ with evident formation of soft tissue lumps and some of the patients of Campanacci stage Ⅱ with major tumors. Extended curettage with adjuvant treatment of the capsule wall and functional reconstruction provides a satisfactory treatment for giant cell tumor of bone.