多发性骨髓瘤的外科治疗探讨

Surgery for multiple myeloma of the bone

目的 探讨多发性骨髓瘤外科治疗的手术指征、方式和效果。 方法 总结分析了 2 9例孤立性骨髓瘤和多发性骨髓瘤患者的临床表现及外科治疗情况。本组病例男 17例 ,女 12例。年龄 3 8～ 76岁 ,平均 59 5岁。原发病灶位于脊柱 9例 ,肋骨 1例 ,肱骨 2例 ,股骨上端 2例 ,股骨干 4例 ,骨盆 5例 ,骶骨 6例。这 2 9例患者分别进行了下列外科治疗 :行单纯病灶清除 12例 ,其中 6例为骶骨骨髓瘤 ,5例为骨盆部骨髓瘤 ;行脊柱前路病灶清除减压、钛网置入钢板内固定 6例 ;行脊柱后路病灶清除减压、经椎弓根内固定 3例 ;5例病理性骨折患者分别行肿瘤刮除、骨水泥填充 ,髓内钉或DHS内固定 ;3例患者行肿瘤切除 ,人工假体置换。文章评估了手术后疼痛、神经损害症状、脊柱不稳等症状的改善 ,生活质量及生存情况。 结果 疼痛改善最明显 ,所有患者均有疼痛减轻。 3例截瘫患者 ,一例由Frankal分级B级变为C级 ,2例由C级变为D级。术后平均随访 1 5年。 3例局部复发。 结论 对有严重神经功能损害和严重影响患者生存质量的合并症的多发性骨髓瘤患者来说 ,外科手术治疗是一种有效可行的治疗方法 ,再结合化疗和放疗 。

Objective To investigate the indication, approach a nd results of the surgical treatment of multiple myeloma. Methods The authors reported 29 surgically-treated patients with solitary or multiple myeloma of the bone between January 1997 and January 2002. There are 17 males and 12 females with average age of 59 5 years (range 38-76 years). The primary tumour localizations were : vertebral column in 9, rib in1, humerus in 2, proximal femur in 2 , femur shaft in 3, pelvis in 6, sacrum in 6. The 29 patients had undergone the following surgical procedures: vertebral tumours were excited through the anterior or posterior approach, combined with a stabilizing procedure in 7 cases. Tumors on thoracic spine were resected using anterior approach. 4 endoprotheses of replacement were performed, indnding two on proximal femur, one on humerus, and one on pelvis. The pathologic fracture was fixated by internal fixation. Neurological impairment was evaluated according to Frankel system. The study evaluated the complications, neurologic function improvement, life quality, and survival after the surgical treatment. Results The pain was relieved in all cases and the neurological function was improved after the surgery. Local recurrence were found in three cases during the follow-up time. Conclusion The symptom of the patients can be relieved by the surgery. Our experience suggests that surgical interruption on multiple myeloma in some cases may be rewarding.