摘要
目的 回顾性总结骨盆肿瘤的外科治疗经验,重点介绍“原位分离+高温灭活”的保肢技术。方法 自1992年1月～2000年3月共治疗骨盆肿瘤133例,其中外半骨盆截除术50例,内半骨盆切除后体外灭活再植或旷置术10例,高温灭活保肢术73例。高温灭活保肢组中IB期肿瘤21例,ⅡB期24例,ⅢB期2例,界限性或高度侵袭性肿瘤19例,另有Ewing肉瘤2例,转移癌5例。结果 外半骨盆截除组多为晚期病变而无法单独切除者,截止至2000年3月最后随访时,除7例失访外,存活1～8年者22例,死亡21例。内半骨盆切除组存活7例,但并发症高,功能差。高温灭活保肢组中IB期或骨巨细胞瘤共40例均得到局部控制,ⅡB期控制率70.8％（17/24）,2例Ewing肉瘤得到局部和全身控制,ⅢB期或转移癌7例中2例无瘤存活两年以上。与目前常用的其它类型的保肢手术相比,髋关节功能优良率明显提高。结论 除晚期肿瘤病例不得已施行半骨盆截除术外,对适宜的病例应用“原位分离+高温灭活”技术是治疗骨盆肿瘤的一种新的有效手段,值得继续使用及改进。
Objective To report the experience of limb salvage, the 'separation plus thermortherapy in situ in the treatment of pelvic tumors. Methods From January 1992 to March 2000, 133 patients with pelvic tumors were treated. Of them, 50 patients underwent hindquarter amputation, 10 underwent internal hemipelvectomy and replantation after extrocorporal devitalization by γ-ray, 73 underwent 'separation plus thermortherapy in situ' for limb salvage. In this series, 40 patients classified as stage IB, 24 as stage ⅡB and 2 as stage ⅢB. Among them, there were 2 Ewing sarcoma and 5 metastasis cancers. Results In the group of hemipelvectomy, 22 patients survived up to the latest follow-up date (March 2000), 22 in 1 to 8 years, 21 died at the latest follow-up. The other 7 who lost to follow-up were excluded in this study. In the group of internal hemipelvectomy, the survival rate was 70% (7/10), but the complications were higher and the function was not satisfactory. In the group of limb salvage by thermotherapy, all of the 40 patients with stage IB tumors or aggressive tumors were under local control. Of 26 patients with stage ⅡB tumors, 19 survived without evident of tumor after 1 to 6 years follow-up. The survival rate was 70. 8% (17/24). Two patients with Ewing sarcoma went well. Among the 7 patients with stage ⅢB tumors or metastasis cancers, 2 patients survived more than 2 years without evidence of the tumor. Compared with the data in the literature, the function was much better. Conclusion Hindquarter amputation probably should be reserved for the advanced tumors. 'Separation plus thermortherapy in situ for limb salvage is a novel and an effective method to deal with pelvic tumors. Although our experience has not been uniformly satisfactory, the method is worth of practice and the results can be further improved.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2002年第8期482-487,共6页
Chinese Journal of Orthopaedics
