骨盆恶性或高度侵袭性骨肿瘤微波高温灭活保肢术

Treatment of malignant or highly aggressive bone tumors of pelvis by microwave-induced hyperthermia

[目的]有相当比例的原发或继发恶性骨肿瘤发生在骨盆部位,目前常用的外科治疗方法是荷瘤盆骨的切除及恢复骨盆连续性的重建。该手术创伤大,局部复发率高,术后功能差,是骨科医生公认的极具挑战性的难题。[方法]本文介绍一种全新的外科术式:将荷瘤盆骨从正常组织中分离,将微波天线均匀地插入瘤块内,输入电磁能量,通过热凝固达到杀灭瘤细胞的目的,勿需特殊的重建措施(不包括植骨等加固措施)。[结果]从1994年5月到2005年12月,152例骨盆恶性肿瘤患者接受了上述疗法,IB期病人中48例得到良好的局部和全身控制,61例IIB期患者,19例死于肿瘤播散,42例经过术后3～11年的观察,未发生远隔转移或局部复发,24例骨盆转移癌患者,11例于术后6个月～3年内死亡,13例病人在观察期1～7年内尚存活,无肿瘤存在迹象。在存活病人中,多数获得美容学和功能学上均可接受的肢体。[结论]该方法被证明为一种行之有效的途径,极大地简化了手术,改进了肿瘤学预后,明显改善了患肢的功能。

[ Objective ] To analyze the treatment of malignant of highly aggressive bone tumors of pelvis by microwave - in- duced hyperthermia. [ Methods ] A novel surgical model was devised ： after careful dissection of the tumor - bearing bone from surrounding normal tissues, the microwave antennae array was inserted into the tumor mass for emitting electromagnetic micro- wave which produced tumor cellular death via thermo - coagulation. No special reconstruction procedure was necessary, except- ing the strengthening measures. [ Results] From May 1994 to December 2005, 152 patients with pelvic malignant or highly ag- gressive tumors received radical thermotherapy. Among 67 patients with stage IB tumors, 48 patients achieved local and system- atic control. Among 61 patients with stage liB tumors, 19 patients died from lesion, and the remaining 42 patents did not devel- oped either metastasis or local recurrence after 3 to l 1 years. Of 24 patients with pelvic metastatic lesions, 11 patients collapsed during six months to three years, and 13 patients still lived without evidence of disease within one to seven years. In the majority of the patients, functional and cosmetic acceptable limbs were reserved. [ Conclusion] The results revealed that the novel and greatly simplified method is justified from both oncological and functional standpoints. Hyperthermia should deserve more atten- tion than it has in this field.