骨盆环区域骨肿瘤的外科治疗

Surgical treatment of bone tumors of pelvic ring region

评价半骨盆截除术、内半骨盆切除体外灭活再植或单纯旷置术、插入式微波天线阵列诱导高温原位灭活水治疗骨盆部骨肿瘤；部分切除术及前后联合入路局部刮除并辅助以局部单纯放疗或（和）置管持续灌注化疗术治疗舱骨肿瘤的效果．探讨骨盆环区域骨肿瘤的各种外科治疗方法的优缺点，以便更有效地治疗该部位肿瘤．方法：7a中外科治疗骨盆环区域各类良、恶性骨肿瘤146例，其中应用半骨盆截除术治疗晚期骨盆骨肿瘤44例；内半骨盆切除体外灭活再植或单纯旷置术治疗骨盆部骨肿瘤Ic例；插入式微波天线阵列诱导高温原位灭活术治疗骨盆部骨肿瘤42例；部分切除术及前后联合入路局部刮除术后局部单纯放疗或（和）置管持续灌注化疗术治疗各类船骨肿瘤SO例．平均随访3a以上，从肿瘤学、肢体关节功能学、并发症等方面综合评价上述各种外科治疗方法的代、缺点．结果：44例半骨盆截除患者仅存活16例．仅有少数年轻患者术后可佩带假肢行走，但步态极差；内半骨盆截除后体外灭活再植或旷置水1o例患者中，复发1例；死亡2侧；感染3例；肢体关节功能优良率为4o％．应用插入式微波天线阵列诱导高温原位灭活治疗骨盆骨肿瘤42例；8例局部复发，其中5例死亡．其余34例中肢体关节功能25例为优。9例尚可．2例感染，1例坐骨神经热损伤．

AIM: To assess the effectiveness of different sur-gical methods used in the treatment of bone tumors of pelvicring region and to evaluate the advantages and disadvantagesof the following methods: hindquarter amputation, internalhemipelvectomy, thermotherapy with inserted microwave an-tenna arrays induced hyperthermia, and partial sacrum resec-tion with or without local radiotherapy, or regionalchemotherapy after curettage through the incision of anteriorand posterior combined approach- METHODS: 146 patientswith bone tumors occurred at pelvic ring region were surgi-cally treated for the past 7 years, with average follow-up of 3years. Of the l46 cases, 44 were treated with hindquarteramputation, including wide hemipelvectomy, 1O with internalhemipelvectomy and reconstruction, 42 with inserted mi-crowave antenna arrays induced hyperthermia thermothera-py, and 5O with partial sacrum resection with or without localradiotherapy, or regional chemotherapy after curettagethrough the incision of anterior and posterior combined ap-proach- All cases and different surgical methods were ana-lyzed in terms of oncology, function and complications. RE-SULTS: Of the 44 patients treated with hindquarter amputa-tion, there were only 16 patients alive and only a few youngpatients were able to walk with artificial limb. Of those 1opatients treated with internal hemipelvectomy, one recurred,two died from metastasis and three got infected, with the rateof excellent and good joint function being 4O%. Of the 42 pa-tients treated with inserted microwave antenna arrays inducedhyperthermia thermotherapy, there were 8 recurrence, 5 ofwhom died. Among the other 34 patients, 25 patients had ex-cellent limb and joint function and 9 patients had fair func-tion. lnfection occurred in 2 patients and sciatic nerve heat in-jury in 1 patients. Of the fifty patients with sacrum tumorstreated by partial sacrum resection with or without radiother-apy, or chemotherapy after curettage through the incision ofanterior and posterior combined approach, 9 patients died and2 recurred. The other 39 patients all had the tumor 1ocallycontrolled, among whom 32 tumors were at the high level ofsacrum and were treated by local radiotherapy or chemothera-py after curettage through the incision of anterior and posteri-or combined approach and only 1 cases recurred. CoNCLU-SIoN: The methods introduced herein are safe and effectivesurgical methods to treat patients with bone tumors if theyare not at late stage and have to be treated with widehindquarter amputation.