骨的恶性纤维组织细胞瘤诊治分析

Diagnosis and treatment of malignant fibrous histiocytoma of bone

[目的]探讨骨的恶性纤维组织细胞瘤的临床特点、诊断及治疗方法。[方法]回顾性分析52例骨的恶性纤维组织细胞瘤患者的临床资料,包括发病部位、术前影像学检查、穿刺活检、肿瘤外科分期、治疗方法以及随访结果等。[结果]52例患者肿瘤位于膝关节周围32例、肩关节周围14例、股骨近端3例,跟骨、腰椎、髂骨各1例。术前常规行X线片、CT及MRI,并行穿刺活检。根据Enneking肿瘤外科分期,20例属于ⅡA期,32例属于ⅡB期。所有病例除1例保守治疗外,其余均行手术治疗,以保肢术为主,保肢率74.5%(38/51),同时进行术前、术后化疗及术后放疗。36例患者经过长期随访,随访率69.2%(36/52),其中局部复发9例,远处转移6例,5年生存率61.1%(22/36)。[结论]术前穿刺活检结合影像学检查对恶性纤维组织细胞瘤的诊断有很大帮助,治疗以保肢手术为主,术前、术后化疗以及术后放疗可以防止肿瘤复发,肿瘤的彻底切除是骨的恶性纤维组织细胞瘤治愈的关键。

[ Objective] To approach the clinical characteristic, diagnosis and method of treatment of malignant fibrous histiocytoma of bone. [ Method] The clinical data of 52 patients of malignant fibrous histiocytoma of bone were analyzed retrospectively, including sites of tumor, preoperative imageology, puncturing biopsy, surgical staging of tumor, methods of treatment, results of follow-up, and so on. [Result] In all 52 cases of malignant fibrous bistiocytoma of bone, 32 cases were in periphery of knee joint, 14 cases in periphery of shoulder joint, 3 cases in the proximal femur, 1 case in calcaneus, 1 case in lumbar and 1 case in ilium. The preoperative imageelagy and puncturing biopsy were made as usual. There were 20 cases in staging of Ⅱ A and 32 cases in in staging of Ⅱ B according to Enneking＇s surgical staging of tumor. All cases were performed operation except of 1 case. The operation were made salvage limb mostly and the ratio of limb salvage was 74. 5 % （38/51）. The preoperative and postoperative chemotherapy and radiotherapy were performed at the same time. Thirty-six of all cases were in longtime follow-up and the ratio of follow-up was 69. 2% （36/52）. Nine cases were recurred in the region, 6 cases had distant metastasis and survival rate of 5 years was 61.1% （22/36）. [ Conclusion] Preoperative puncturing biopsy and imageology can help the diagnosis of malignant fibrous histiocytoma of bone. Surgery is the primary method and radiotherapy and chemotherapy can prevent the recurrence of the tumor. The resection of the tumor thorough is the key point of healing of malignant fibrous histiocytoma of bone.