肢体骨肿瘤活检失误临床分析

Clinical analysis about biopsy mistake of limb bone tumors

目的分析临床上骨肿瘤活检手术中的常见失误,降低活检手术给骨肿瘤保肢手术带来的不利影响。方法分析55例骨肿瘤活检手术失误患者的所有临床资料,包括男25例,女30例,平均年龄26.6岁。肿瘤部位包括股骨近端12例,股骨远端13例,胫骨上端17例,胫骨干及胫骨远端3例,腓骨近端2例,肱骨近端及肱骨干5例,桡骨远端3例。肿瘤诊断:骨肉瘤28例,皮质旁骨肉瘤3例,骨巨细胞瘤6例,恶性纤维组织细胞瘤6例,软骨肉瘤6例,恶性淋巴瘤1例,转移癌3例,尤文氏瘤2例。结果55例患者中,17例因为活检手术失误及相关并发症而行截肢手术,占30.9%。4例切除活检失误均为切除范围不足。9例穿刺活检失误中,6例穿刺活检的入路太靠近主要血管神经束,3例发生诊断失误。42例切开活检失误中,以手术入路失误为多,共31例,占73.8%。切开活检并发症中,开窗不当造成病理性骨折2例,止血不彻底形成较大血肿7例,术后引流放置不恰当5例。结论骨肿瘤活检手术失误严重影响骨肿瘤患者的后续治疗,临床上应引起足够的重视。

Objective To analyze common pitfalls in biopsy of bone tumors to decrease the adverse effect on limb salvage operations. Methods Clinical data of 55 patients with bone tumors including 25 males and 30 females with average age of 26.6 years were analyzed. They were all admitted from other hospital. Tumors were located at proximal femur in 8 cases, distal femur in 13 cases, proximal tibia in 17 cases, distal and shaft of tibia in 3 cases, proximal fibula in 2 cases, proximal and shaft of humerus in 5 cases and distal radius in 3 cases. Twenty-eight cases were diagnosed as osteosarcoma, 3 as juxtacortical osteosarcoma, 6 as giant cell tumor, 6 as malignant fibrous histiocytoma, 6 as chondrosarcoma, 1 as malignant lymphoma, 5 as metastatic carcinoma and 2 as Ewing＇ s sarcoma. Results Among 55 patients, 17 patients （30.9%） were performed amputation due to biopsy pitfalls and complications. Inadequate tumor resection occurred in 4 excisional biopsies. Nine pitfalls happened on punctural biopsy, including 6 puncture approaches, which was too close to the important vascular nerve bundles and 3 misdiagnoses. Thirty-one pitfalls （73. 8% ） of operative approach happened on 42 open biopsies. The complications of open biopsy included 2 pathologic fractures, 7 hematomas and 5 inappropriate drainages. Conclusion Pitfalls in biopsy have serious effect on the further treatment of patients with bone tumors and should be paid much attention to clinically.