摘要
目的观察吡柔比星辅助化疗结合保肢手术治疗骨肉瘤术后康复锻炼及临床疗效。方法观察组的患者实行吡柔比星辅助化疗结合保肢手术再加手术后的辅助化疗进行治疗,对照组的患者不实行吡柔比星辅助化疗。具体方法是吡柔比星辅助化疗的方案是采用吡柔比星+顺铂+甲氨蝶呤+异环磷酰胺。第二,保肢手术,手术遵循的原则是囊外要彻底切除,切缘距离肿瘤≥5cm,手术之后评价被切除肿瘤处的坏死率,坏死率>90%者,手术之后的辅助化疗可以采用原来的剂量和方案。患者的肿瘤骨组织被切除以后经过CO射线灭活以后再在原位植入,固定之后将缺损处用骨水泥填塞。瘤段骨切除灭火再植术38例,人工膝关节置换术、人工关骨节置换术、骨缺损段置换术共24例。第三,手术之后的辅助化疗方案同手术前相同,疗程为4周,对症下药处理化疗中产生的不良反应。结果观察组治疗后肢体功能Enneking评分较对照组高,差异有统计学意义(P<0.05);观察组优良率为69.8%,对照组为52.0%,观察组比对照组高,但不具有统计学意义(P>0.05)。观察组治疗后局部复发、转移率为12.76%明显低于对照组的35.96%,差异有统计学意义(P<0.05)。2组1年生存率、2年生存率比较差异无统计学意义(P>0.05);观察组3年生存率为80.64%明显高于对照组的55.36%,差异有统计学意义(P<0.05)。结论吡柔比星辅助化疗结合保肢手术治疗骨肉瘤患者与单纯使用保肢手术进行治疗相比,有利于提高患者的肢体功能,使患者的生存时间延长,生命质量提高,值得在临床治疗中推广。
Objective To observe the rehabilitation exercise and clinical effect of the treatment of osteosarcoma with the aid of the combined treatment of the patients with the treatment of osteosarcoma. Methods The patients in the observation group were treated with chemotherapy combined with limb salvage chemotherapy combined with limb salvage surgery plus adjuvant chemotherapy. The specific method is pirarubicin chemotherapy scheme is using pirarubicin ＋ cisplatin ＋ methotrexate ＋isofosfamide. Second,limb salvage surgery,the principle is to follow the principle is to completely remove the capsule,cut edge distance of the tumor at least 5cm,after surgery evaluation of the tumor necrosis rate,if the necrosis rate of 90% or more,the adjuvant chemotherapy after surgery can be used in the original dosage and program. The tumor bone tissue was removed by C0 ray and then implanted in the bone. Tumor segmental resection extinguishing replantation in 38 cases,total knee arthroplasty,artificial closed joints replacement,bone defect in the replacement of a total of 24 cases. Third,after the surgery,adjuvant chemotherapy is the same with before operation,treatment for 4 weeks,suit the remedy to the case processing chemotherapy adverse reactions. Results Two groups of patients after treatment,limb function Enneking score compared to the observation group than the control group,the difference was statistically significant（ P 〈 0. 05）,the observation group was 69. 8%,the control group was 52%,the observation group was higher than the control group,the difference was not obvious,not statistically significant（ P 〉 0. 05）. After treatment,the local recurrence and metastasis rate of the observation group was 12. 76%,the control group was 35. 96%,the observation group was lower than the control group,the difference was statistically significant（ P 〈0. 05）,the one year survival rate of the observation group and the control group were not obvious,and the two year survival rate was not statistically significant（ P 〉 0. 05）. The three year survival rate in the observation group was 80. 64%,the observation group was higher than the control group,the difference was statistically significant P 〈 0. 05. Conclusion Compared with the treatment of patients with osteosarcoma in patients treated with limb salvage surgery combined with limb salvage surgery,it is beneficial to improve the limb function,prolong the survival time and improve the quality of life. It is worthy to be popularized in clinical treatment.
出处
《临床合理用药杂志》
2016年第5期11-12,14,共3页
Chinese Journal of Clinical Rational Drug Use
关键词
吡柔比星
化疗
保肢手术
骨肉瘤
疗效
Pirarubicin
Chemotherapy
Limb salvage operation
Osteosarcoma
Curative effect
