保肢手术与个案化疗治疗骨肉瘤临床研究

THE CLINICAL TREATMENT OF OSTEOSARCOMA BY THE LIMB SALVAGE OPERATION AND SELECTIVE NEOADJUVANT CHEMOTHERAPY

为增加瘤段骨灭活的彻底性，缩短其手术灭活时间，并实施手术前后多种有效药物的个案化疗，而进行了瘤段骨超声灭活再植保肢手术与瘤细胞培养敏感药物个案化疗治疗骨肉瘤临床前瞻性随机对照研究。结果表明，观察组瘤段骨术中灭活时间明显缩短（约２０ｍｉｎ），随访期内（平均２．５ａ）无瘤生存率（６６．７％）高于对照组（手术前后固定方案非选择性化疗加单纯酒精灭活再植术）（２３．５％；Ｐ＜０．０５）。其术后合并症、局部复发及转移或死亡的发生率较对照组减低，但无统计学差异（Ｐ＞０．０５）；术后患肢功能评定结果两组间无差异。提示瘤段骨超声灭活再植保肢手术与瘤细胞培养敏感药物个案化疗，是一种方法简便、疗效较好、经济节俭行之有效的方法之一。

In addition to the neoadjuvant chemotherapy of the sensitive drugs to the tumor cell cultured,the patients with nonmetastic osteosaroma of the extremities were treated with the local wide resection and the replantation of the resective tumor bone treated with the bactericide dose ultrasonic wave by the medium of 95% alcohol.The patients of control group were of the local wide resection and the replantation of 95% alcohol killing resective tumor bone and the standard neoadjuvant chemotherapy.The mean follow up was 2.5 years.The result showed that the 2.5year disease free survival rate of the patients with the new treatment method was higher than that of the patients of the control group(66.7%,23.5% respectively;P<0.05); The patients with the postoperation complications and the local recurrence was less than ones of the control group.In two groups the recovery of extremity ability after surgery was the same. Moreover,the killing time of the resective tumor bone during operation was shortened remarkably.In conclusion, it is recommended that the replantation of the resective tumor bone treated with the ultrasonic wave and the neoadjuvant chemotherapy of the sensitive drugs to the tumor cell cultured should be an effective method to treat the nonmetastatic osteosarcoma of the extremities.