微波消融在Campanacci Ⅲ级肢体骨巨细胞瘤外科治疗中的应用

Application of microwave ablation in the treatment of Campanacci grake Ⅲ giant cell tumor of bone of the limbs

目的:探讨微波消融在Campanacci Ⅲ级肢体骨巨细胞瘤(GCTB)患者外科治疗中临床应用的可行性及效果。方法:回顾性研究。纳入2009年7月—2017年4月山东大学齐鲁医院骨肿瘤科接受手术治疗的Campanacci Ⅲ级肢体GCTB患者25例。按手术治疗方式分为两组:微波刮除组12例,其中男7例、女5例,年龄34~69(40.6±10.8)岁,桡骨远端1例、股骨近端2例、股骨远端6例、胫骨近端1例、腓骨近端2例;整块切除组13例,其中男7例、女6例,年龄29~68(46.0±10.5)岁,肱骨近端1例、桡骨远端2例、尺骨远端1例、股骨近端2例、股骨远端5例、胫骨近端1例、腓骨近端1例。比较两组手术时间、术中出血量、手术并发症情况,术后肿瘤复发率、疼痛视觉模拟评分法(VAS)评分、肌肉骨骼肿瘤协会(MSTS)功能评分。结果:两组患者均顺利完成手术,术中未发生重要血管神经损伤。微波刮除组手术时间103~160(121±20)min、术中出血量70~110(85±16)mL,低于整块切除组的119~169(147±19)min和105~225(176±36)mL,差异均有统计学意义( t=3.266、8.158, P值均<0.01)。两组患者均获得随访,随访时间24~72个月(平均31.17个月),术后3个月时微波刮除组VAS评分为1~3(2.25±0.62)分,低于整块切除组的3~4(3.23±0.44)分,差异有统计学意义( t=4.588, P<0.01)。术后1年微波刮除组MSTS评分为27~30(28.33±0.98)分,高于整块切除组的25~28(26.08±1.03)分,差异有统计学意义( t=5.566, P<0.01)。微波消融组术中无血管、神经灼伤,术后无病理骨折;整块切除组假体松动1例,发生于术后26个月,予假体翻修手术治疗。 结论:微波消融联合病灶刮除术应用于Campanacci Ⅲ级肢体GCTB的外科治疗具有可行性,手术并发症少、术后肢体功能好,且术后肿瘤复发率与切除治疗相似。

Objective This work aims to investigate the feasibility and clinical efficacy of microwave ablation in the treatment of Campanacci gradeⅢgiant cell tumor of bone(GCTB)of the limbs.Methods Retrospective analysis was conducted from July 2009 to April 2017.A total of 25 patients with GCTB of CampanacciⅢin the limbs were treated by operation and were divided into the microwave curettage(12 cases)and en bloc resection(13 cases)groups.The microwave curettage group comprised seven males and five females,aged 34-69(40.6±10.8)years;the locations of the disease were as follows:one in the distal radius,two in the proximal femur,six in the distal femur,one in the proximal tibia,and two in the proximal fibula.The en bloc resection group consisted of seven males and six females,aged 29-68(46.0±10.5)years;the locations of the disease were as follows:two cases in the distal radius,one case in the proximal humerus,two cases in the proximal femur,five cases in the distal femur,one case in the proximal tibia,one case in the distal ulna,and one case in the proximal fibula.The operation time,bleeding volume,recurrence rate,visual analog score,Musculoskeletal Tumor Society(MSTS)functional score,and complications of the two groups were compared.Results All operations were successfully performed,and no significant vascular and nerve injury were noted during the operation.The operation time of the microwave curettage group took 103-160(121±20)min,which was significantly different from that of the en bloc resection group(119-169[147±19]min,t=3.266,P<0.01).A significant difference was found in the amount of bleeding between the microwave curettage group(70-110(85±16)mL)and the en bloc resection group(105-225[176±36]mL,t=8.158,P<0.01).Both groups were followed up for 24-72 months(average 31.17 months).The mean VAS score of the microwave curettage group was 1-3(2.25±0.62)at 3 months post operation,which was more statistically significant(t=4.588,P<0.01)than that of the en bloc resection group 3-4(3.23±0.44);moreover,the mean MSTS score of the microwave curettage group was 27-30(28.33±0.98)at 1 year post operation,which was more statistically significant(t=5.566,P<0.01)than that of the en bloc resection group(25-28[26.08±1.03]).No cases of vascular or nerve burns and pathological fractures were noted after microwave ablation.One patient in the en bloc resection group suffered from the loosening of prosthesis 26 months after surgery and then underwent revision surgery.Conclusions Microwave ablation combined with curettage can obtain fewer complications and better limb function in CampanacciⅢGCTB in the limbs;nevertheless,it can obtain a similar recurrence rate with the resection group.