骨转移癌的外科治疗

Surgical Treatment of Bone Metastasis

目的：探讨骨转移癌的外科治疗原则、手术方法及临床价值。方法：1983年4月至1998年3月，79例有随访结果的骨转移癌患者行Guy′s疼痛分级和Karnofsky评分，测量X线平片中长骨骨皮质破坏厚度(或椎体骨折塌陷的程度）和肿瘤体积做为定量计算指标。依据全身状况和骨转移灶特征将患者分为4组，并作为包括手术在内的综合治疗的依据。对比治疗前后的Guy′s疼痛分级和Karnofsky评分结果并作统计学分析。结果：本组平均随访28．5个月。79例患者中60例接受综合治疗，早期缓解率56．7％。有病理骨折或骨折危险性的患者治疗后早期缓解率为68．6％。其中25例患者接受大段异体骨关节移植，依据Mankin′s异体骨移植评价标准，术后总评优良率为88．0％。接受治疗与未行治疗的患者相比，疼痛减轻，Karnofsky评分增加，统计学处理显示治疗效果显著。结论：根据骨转移癌分组标准进行有选择性的综合治疗可以提高患者终末期的生存质量和生命活力，在临床应用具有一定的适用性。大段异体骨关节移植治疗骨转移癌可取得满意的疗效。

Objective： The aim of this study is to characterize the principles of surgical treatment for bone metastasis ， and evaluate the therapeutic strategy． Methods： From 1983 to 1997， seventy－three patients with bone metastasis were divided into 4 groups (stage I to IV) according to their Guy＇s ache degree， Karnofsky score and X－ray characters． Forty－two patients (57．5％) were treated by recommended therapy while the others were not． All patients were assessable and followed－up (median 28 months)． Results： Statistically significant reduction of Guy＇s ache degree， acceleration of Karnofsky score and better life activities after recommended treatment were observed． The principles of surgical treatment proposed in this study may prompt the levels of diagnosis and treatment of bone metastasis． Conclusion： Comprehensive treatment including operation may improve the patient＇s life quality and play an important role in medical practice．