高危骨肉瘤的临床特点及治疗对策_医学论文.docVIP

高危骨肉瘤的临床特点及治疗对策_医学论文 高危骨肉瘤的临床特点及治疗对策_医学论文 作者：王臻　黄耀添　黄鲁豫　赵金康　于会东　刘继中　杜晓川　李敬帮　晏培松　王志祥 【关键词】 骨肉瘤 关键词: 骨肉瘤危重病综合治疗 摘 要:目的 通过分析61例骨肉瘤预后因素及生存率，探讨高危骨肉瘤临床特点及治疗对策，报告16例高危骨肉瘤治疗经验. 方法 以经肢体挽救手术治疗有完整随访资料的61例骨肉瘤为基础，寿命表法计算生存率，采用图像分析技术对肿瘤预后相关因素包括肿瘤的绝对长度、绝对宽度、绝对深度、绝对面积、软组织肿块最大横径进行分析. 结果 61例骨肉瘤随访1～10a，5a生存率57.5%，外科分期III期骨肉瘤与宿主骨面积比≥2/3软组织肿块最大横径≥6cm病理骨折活检标本PCNA阳性细胞检出占平均视野2/3以上均属高危骨肉瘤.采用术前多次化疗，深静脉持续给药高选择骨肉瘤原发灶和转移灶滋养动脉化疗并栓塞术前放疗和肢体挽救术处理高危骨肉瘤16例，随访1.5a，死亡2例，带病存活5例，无病存活9例，保肢率68.7%. 结论 本研究使一些高危骨肉瘤得到了积极救治，更具备综合性和肿瘤针对性. Abstract:AIM We discussed the characteristics and treat-ment of high-risk osteosarcoma by analyzing prognostic factor and survival rate of61osteosarcoma patients，and reported some experience.METHODS Depending on61osteosarco-ma patients who undertook limb-salvage operation and had integrity following-up data，we adopted image analyzing tech-nology to process the prognostic factors，which included ab-solute tumor length，width，depth，area and maximum trans-verse diameter.RESULTS 61osteosarcoma cases had been followed up for10years.Five-year survival rate was57.5%.The high risk factors included III surgery stage，higher than2/3area ratio of sarcoma to host bone，more than6centime-ters maximum transverse diameter，pathological fracture，and higher than2/3positive area per sight scope of PCNA in biopsy specimen.Then we undertook repeated pre-operation chemotherapy，high selective artery embolism and chemotherapy，and salvage procedures for16high risk os-teosarcoma patients，there were2death，5survival with tu-mor and9non-tumor survival after18months following-up，and the successful salvage rate was68.7%.CONCLUSION Our research leads the active treatment to high risk os-teosarcoma，aims directly at the osteosarcoma and provides comprehensive treatment project. 　　0 引言 　　骨肉瘤的预后判断和临床诊治一直是骨肿瘤领域中的难点和重点，虽然目前探讨的方法很多，但仍没有在实用性和有效性之间找到平衡，我们依据本科室大量临床实践和实验资料进行了有益的探讨. 　　1 对象和方法 　　1.1 对象 我科1987-05/1996-12行肢体挽救手术治疗的有完整随访记录的骨肉瘤患者61例. 　　1.2 方法 计算机图像分析X线片:①肿瘤绝对长度（absolute tumor length，ATL）:测