术中局灶化疗辅以增生平片治疗四肢骨巨细胞瘤21例临床观察

The clinical analysis of 21 cases of giant cell tumor of bone in limbs: local focus chemotherapy in the course of operation and Zengshengping tablet adjuvant after operation

目的 :手术中使用氨甲蝶呤、顺氯氨铂、阿霉素局灶化疗 ,手术后辅以增生平片口服以减少骨巨细胞瘤的复发 ,并保存患肢功能。方法 :手术中彻底刮除病灶 ,瘤腔壁一次性用氨甲蝶呤灭活(氨甲蝶呤 30mg +NS1 5ml～ 30ml浸湿明胶海绵均匀贴附于瘤壳内壁上 ) ,植骨块用顺氯氨铂 2 0～ 30mg+NS5 0ml浸泡 30min后充填瘤腔 ,植骨瘤腔置管隔日灌注氨甲蝶呤 30mg ,每 2日一次共 3次 ;充填骨水泥中一次性加入阿霉素 80mg。术后口服增生平片 ,每日 2次 ,每次 8片 ,持续 6个月。结果 :治疗 2 5例患者 ,2 1例获随访 ,时间 2～ 5年 ,2例复发。结论 :术中使用氨甲蝶呤及顺铂或阿霉素局灶化疗 。

Objective :Methotrexate(MTX),Cisplatin(PDD),Adriamycin(ADM) were used in the operation,Zengshengping tablet was oral used to decrease the relapse of giant cell tumor of bone(GCT) after operation .Limb salvage was needed in the operation.Methods: Focuses were scraped thoroughly, tumor cavity walls were exterminated with MTX only for once, that is, the soaked sponges were even distributed on the internal shells of tumor with MTX30mg+NS 15～30ml. The lumps of transplanted bones were immensed for thirty minutes with PDD20mg+NS50ml, filled to the tumor cavity and pipes placed with MTX 30mg pouring into it once every two days,three times in all.ADM 80 mg was added to polymethylmeth-acrylate cementage for only once. Zengshengping tablet was oral used 8 Plan, two times a day, lasted for 6 months. Results: 21 cases were followed for 2 to 5 three years among the 25 treated patients. 2 patients relapsed.Conclusion:The therapy used in this article has played a certain role to reduce the still and active GCT relapses. Local focus chemotherapy with MTX+PDD+ADM in the operation and Zengshengpingtablet used after operation is an effective treatment.