肺癌四肢骨转移20例手术治疗的回顾性分析

Retrospective analysis of surgical treatment of limb bone metastases from lung cancer

目的：探讨肺癌四肢骨转移手术治疗方法、术后生活质量、肢体功能及生存率。方法2006～2010年我科收治肺癌四肢骨转移病例20例。骨转移癌部位中股骨11例，肱骨3例，尺骨4例，髂骨1例，指骨1例。20例患者均行瘤段切除保肢重建术，其中人工关节置换11例，瘤段切除灭活回植4例，同种异体骨重建3例，单纯切除2例。结果随访时间5～30个月，平均14.2个月。所有患者术前疼痛评分为7.56±1.43，术后1个月疼痛评分为2.31±0.95，术后疼痛症状明显改善（P＜0.05）。术前生活质量平均为27.93±8.64，术后3个月生活质量平均为58.42±15.31，术后患者生活质量明显改善（P＜0.05）。术后 MSTS评分范围13～28分，平均为20.16±4.38。结论肺癌骨转移患者采取合适的手术方案，术后可以明显减轻患者疼痛、提高患者生活质量、改善肢体功能，但对患者生存率的影响有待于进一步观察。

Objective To evaluate different operative treatment options for limb bone metastases from lung cancer focusing on surgical procedures, postoperative quality of life, limb function and tumor free survival period. Methods From 2006 to 2010, 20 cases of limb bone metastases from lung cancer were surgically treated in our institution. The metastatic sites included femur （n=11）, humerus （n=3）, ulna （n=4）, ilium （n=1）, phalanx （n=1）. All patients underwent tumor resection and limb reconstruction. Prosthetic replacement was performed in 11, reimplantation after alcohol inactivation in 4, allograft reconstruction in 3 and simple excision in 2. Results Follows-up ranged from 5 to 30 months and the mean course was 14.2 months. The mean preoperative pain score was 7.56± 1.43; the mean postoperative pain score was 2.31 ± 0.95. The postoperative pain symptom had improved significantly （P〈0.05）. The mean preoperative quality of life score was 27.93±8.64; the mean postoperative quality of life score was 58.42±15.31. Thus quality of life had improved significantly （P〈0.05）. Postoperative MSTS score ranged from 13 to 28. The average score was 20.16±4.38. Conclusion For patients with bone metastases from lung cancer, to choose appropriate surgical options is critical. Our result shows that it can significantly reduce pain, improve patients＇ quality of life and improve limb function. But for the survival rate, it remains to be seen.