肩胛骨恶性骨肿瘤微波灭活的临床研究

The clinical study of microwave heliotherapy on the malignant bone tumors of scapula

目的探讨采用微波对肩胛骨原发恶性肿瘤及转移瘤进行原位灭活，保持肩胛骨完整性的可行性和疗效。方法1998年6月至2008年2月对累及肩胛骨的17例原发恶性骨肿瘤及转移瘤患者采用微波原位灭活进行治疗。男12例，女5例；年龄13-59岁，平均48岁。肿瘤类型：原发恶性骨肿瘤12例，转移瘤5例。肿瘤部位：14例累及S1区，3例转移瘤同时累及S1和S2区。17例全部采用肩胛骨背侧入路，根据肿瘤累及区域采用弧形或“□”形切口暴露肿瘤，周围软组织在铜网保护下，用2450MHz微波将肿瘤局部温度加热到50℃，持续20min，然后全部或部分剥离坏死肿瘤组织，保留肩胛骨的支架作用。1例肩胛骨转移性腺癌患者术中切断进入肿瘤的部分腋神经，切除肿瘤后适当游离远、近端直接吻合。结果手术时间60-180min，平均120min；手术失血量300-1000ml，平均460ml。所有患者无严重的术中及术后并发症。随访3个月-10年，平均4．2年。3例肩胛骨Ewing肉瘤患者术后8～24个月出现肺、脑和全身多发性转移而死亡。3例恶性纤维组织细胞瘤患者分别于术后10-22个月因肺转移及全身多发转移而死亡；1例术后6个月复发，带瘤生存。5例肩胛骨转移瘤患者分别于术后6～14个月出现非肩胛骨转移而死亡。其余5例原发恶性骨肿瘤患者随访期间未出现复发或转移。3例患者术后肩关节外展功能受限，前伸、后屈无受限。结论微波原位灭活手术具有操作简便、疗效可靠、易于推广等优点，是一种理想的治疗肩胛骨恶性肿瘤的手术方法。

Objective To investigate the clinical results of microwave heliotherapy on the malignant bone tumors of scapula. Methods Form June 1998 to February 2008, 17 patients with malignant bone tumors of scapula were treated with microwave heliotherapy. There were 12 males and 5 females, 48 years old on the average （ranging from 13 to 59 years）. The tumors included： the primary malignant tumor of the scapula （12 cases）, the metastases of the scapula （5 cases）. Locations of tumors included： the S1 region （14 cases） and both SI and $2 regions of scapula （3 cases）. The exposures of all the tumors were via a ＂□ ＂ shape or curved nick on the surface of scapula. The lesions were heated at 50 ℃for 20 min at 2450 MHz microwave, with surrounding soft tissue protected by copper mesh. The necrotic tumor tissues were excised after the treatment of microwave heliotherapy. Results The axillary nerve of the patient with the metastases of the scapula was cut off, and the broken ends were sewed up after the tumor was excised. The duration of surgery was from 60 minutes to 180 minutes （120 minutes on average）. The blood loss was from 300 ml to 1000 ml （460 ml on average）. All patients were followed up for 3 months to 10 years （4.2 years on average）. Three cases with Ewing sarcoma died due to brain metastases, pulmonary metastases or all body metastases 8 to 24 months postoperatively. Three cases with malignant fibrous histiocytoma died clue to pulmonary metastases or all body metastases 10 to 22 months postoperatively. Five cases with the metastases died due to metastases 6 to 14 months postoperatively. Three patient＇s superduct function of shoulder joint was re- stricted. Conclusion The clinical results demonstrated that the advantages of microwave heliotherapy included quick increase of temperature, sensitive responses, easy control of temperature, and effective inactivation of tumor cells in the malignant bone tumors of scapula.