影像引导下经皮微波消融治疗骨转移癌性疼痛

Image-guided percutaneous microwave ablation in the treatment of cancerous pain for patients with bone metastases

目的探讨影像引导下经皮微波消融治疗骨转移癌性疼痛的手术方法,评估其有效性和安全性。方法对2015年1月至2017年7月在广州军区广州总医院接受影像引导下经皮微波消融手术的8例骨转移癌患者的临床资料进行回顾性分析。其中男6例,女2例,年龄53~74岁(平均61岁);原发肿瘤为肺癌4例、肝癌3例、纤维肉瘤1例,均经影像学及病理学结果明确诊断。根据视觉模拟量表(VAS)疼痛评分标准记录患者术前、术后1 d、7 d、1个月的疼痛程度,采用美国骨肿瘤学会(MSTS)评分对患者术后2周的功能改善情况进行评估。结果住院时间2~4 d(平均3 d),平均随访时间5.4个月(3~12)个月。患者术后VAS疼痛评分明显下降,MSTS功能评分明显增加(P<0.05)。1例患者术中因恶心不适提前中止治疗;1例术后2周出现手术部位伤口感染;4例复发,复发率4/8;死亡3例,总体1年生存率5/8。结论影像引导下经皮微波消融治疗骨转移癌性疼痛,近期效果显著,同时还具有术式安全、操作简便、功能改善明显等优势。

Objective To explore the surgical method of image-guided percutaneous microwave ablation in the treatment of cancerous pain for patients with bone metastases,and to evaluate its safety and efficiency.Methods Clinical data of 8 patients with bone metastases who underwent image-guided percutaneous microwave ablation in Guangzhou General Hospital of Guangzhou Military Command from January 2015 to July 2017,were retrospectively analyzed.Among them,there were 6 males and 2 females,with average age of 61 years old(range 53 to 74 years old),including primary lung cancer in 4 patients,primary liver cancer in 3 and primary fibrosarcoma in 1 patient,whose diagnoses were all determined by radiological and pathological results.According to visual analogue scale(VAS)pain scoring,patients'pain was recorded preoperatively and 1 d,7 d and 1 month postoperatively.The improvement of function at 2 weeks after the surgery was evaluated by American Musculoskeletal Tumor Society(MSTS)score.Results The average hospital stay was 3 d(2 to 4 d),and the average follow-up was 5.4 months(3 to 12 months).Compared to preoperative ones,postoperative VAS pain score and MSTS functional score all improved significantly(P<0.05).Treatment for 1 case was withdrawn due to intraoperative nausea,and surgical site infection occurred in 1 case at 2 weeks after the operation.The local recurrence rate was 4/8 and one-year overall survival was 5/8.Conclusion For patients with bone metastasis who suffered from cancerous pain,image-guided percutaneous microwave ablation appears to be effective in short term,with the advantages of providing safe approach,simple procedure and functional improvement.