微波结合刮除术治疗骨盆转移瘤的临床疗效

The clinical effect of microwave ablation in the treatment of pelvic metastases

目的评价微波消融技术结合刮除术治疗骨盆转移瘤的临床有效性和安全性。方法回顾性分析2015年6月至2019年6月共12例微波消融辅助治疗骨盆转移瘤患者的资料,其中男7例,女5例;年龄为(59.5±10.1)岁(范围:43~79岁)。手术方式选择微波消融、肿瘤刮除、骨水泥填塞,当病变累及骶髂关节面,影响负重弓时加钢板螺钉内固定重建。12例中8例在微波消融后行刮除术、骨水泥填塞加钢板螺钉内固定,4例微波消融后行刮除术、单纯使用骨水泥填塞。术后随访观察指标包括:患者生存率、局部复发率、手术时间、术中出血量、围手术期并发症、疼痛视觉模拟评分(visual analogue scale,VAS)、36条简明健康状况调查量表(Short-Form 36,SF-36)以及骨与软组织肿瘤学会(Musculoskeletal Tumor Society,MSTS)评分系统功能评分。记录术前、术后1周及术后3个月VAS评分和SF-36评分,对随访>3个月者进行MSTS功能评分。结果12例随访4~27个月,平均14.2个月,中位随访时间9个月。至末次随访,12例中死亡7例,生存5例,6个月生存率81.8%,1年生存率为40.9%,2年生存率为27.3%;死亡患者生存时间为8.8个月(范围:5~18个月),中位生存时间7个月。随访期间局部复发率8.3%(1/12),术后平均复发时间为4个月。12例均顺利完成手术,手术时间(101±21)min,术中出血(295±108)ml。12例术前VAS评分中位数为7.5(7,8)分,术后1周VAS评分5(4,5)分,术后3个月5(4,5.75)分,与术前相比患者疼痛明显减轻,差异均有统计学意义(P<0.05)。12例术前SF-36评分中位数23(21,24.75)分,术后1周为47(46,54)分,术后3个月为50.5(47,55.25)分,与术前相比患者的生活质量明显改善,差异均有统计学意义(P<0.05)。12例术后3个月MSTS评分中位数为20.5(16.25,21.75)分,其中优16.7%(2/12),良50%(6/12),可16.7%(2/12),差16.7%(2/12),总体优良率66.7%(8/12)。结论微波消融结合刮除术治疗骨盆转移瘤可以明显缓解局部疼痛,重建肢体功能,改善患者生活质量,是一种可选的骨盆转移瘤治疗方案。

Objective To evaluate the therapeutic effect and safety of microwave ablation plus curettage.Methods Clinical data of a single group of 12 patients admitted to our hospital from June 2015 to June 2019 who underwent microwave ablation for bone metastasis were retrospectively analyzed.There were 7 males and 5 females,with an average age of 59.5±10.1(range from 43 to 79)years old.Curettage plus bone cement after microwave ablation was performedand when the lesion involved the sacroiliac joint surface and impaired the bearing arch,the internal fixation was performed with plate and screws.8 among the 12 patients underwent curettage,bone cement and metal internal fixation after microwave ablation.After microwave ablation,and 4 patients underwent curettage and reconstruction with bone cement alone.The patients were followed up aftersurgery.The observational indicators included:patient survival rate,local recurrence rate,perioperative complications,Operation time,intraoperative blood loss,VAS score,SF-36 score,and MSTS function score.VAS scores and SF-36 scores were recorded before surgery,1 week after surgery and 3 months after surgery.Results 12 patients were followed up for 4-27 months,with an average follow-up time of 14.2 months and a median follow-up time of 9 months.During the follow-up,7 patients died and 5 survived,with a 6-month survival rate of 81.8%,a 1-year survival rate of 40.9%and a 2-year survival rate of 27.3%.The mean survival time of the dying patients was 8.8 months(5-18 months),and the median survival time was 7 months.Operation time was 101±21 min and intraoperative blood loss was 295±108 ml.During the follow-up period,local recurrence rate was 8.3%(1/12),and the average postoperative time to recurrence was 4 months.There were no complications such as wound nonunion,wound infection,deep infection,vascular nerve heat injury and internal fixation failure.VAS score before surgery was 7.5(7,8)points,VAS score 1 week after surgery was 5(4,5)points,and VAS score 3 months after surgery was 5(4,5.75)points(P<0.05).Preoperative SF-36 score was 23(21,24.75)points,1 week after surgery SF-36 score was 47(46,54)points,and 3 months after surgery SF-36 score was 50.5(47,55.25)points(P<0.05).3 months after the operation,the MSTS score was 20.5(16.25,21.75)points,of which excellent 16.7%(2/12),good 50%(6/12),medium 16.7%(2/12),poor 16.7%(2/12),and the overall excellent and good rate was 66.7%(8/12).Conclusion Microwave ablation plus curettage for pelvic metastasis of malignant tumor can significantly relieve local pain,rebuild limb function and improve patients'quality of life,and it`s an alternative treatment for pelvic metastases.