新辅助化疗结合保肢手术治疗骨肉瘤的临床疗效分析.pdfVIP

山西医科大学硕士学位论文 患者在手术前先给予化疗后，化疗的效果表现在：疼痛、不适等症状明显较前好转， 局部肢体的肿胀亦缓解，肿瘤体积明显减小，局部压痛减轻，局部皮温减低，瘤体质 地变硬，邻近关节活动度增大；实验室化验检查示碱性磷酸酶值不同程度的下降，影 像学检查 （包括X线、CT、MRI等）示瘤体交之前都有不同程度变小，与周围组织 界限变清楚，骨质硬化，成骨成份增加或钙化。所有患者在化疗期间均出现不同程度 不良反应。 结论： 新辅助化疗反应良好，能有效的杀死骨肉瘤的微小病灶，对骨肉瘤患者的疗效显 著，能够使骨肉瘤患者的生存率得到提高，没有系统规范化化疗的手术难以取得成功； 瘤段切除人工假体重建术是当下膝关节上下骨肉瘤保留肢体功能的主要方法，新辅助 化疗结合保肢手术是目前治疗四肢骨肉瘤的理想治疗方法，值得我们进一步研究及应 用。 关键词：骨肉瘤；保肢手术；新辅助化疗；疗效观察；不良反应；肢体功能 II 山西医科大学硕士学位论文 Theclinicalefficacyofneoadjuvantchemotherapycombined withlimbsalvagesurgeryforosteosarcoma Abstract Objective: To analyze neoadjuvant chemotherapy combined with limb salvage surgerytreatment andprognosisofpatientswithosteosarcoma; Methods: (1)Atudy: Select hospitalized patients meet the criteria, between May 2005 to May 2014inthe secondsetofthepathologica diagnosisofbonediseasediagnosedHospita of ShanxiMedica University of osteosarcoma,para e neoadjuvant chemotherapy and limb salvagesurgeryosteosarcomapatientstreatedwithpreoperativeX-ray,CT,MRIandwhole body bone scan and other tests found no distant metastasis. Co ect data related to preoperative (clinica manifestations,imagingdata,suchasalkalinephosphatasemeasured values. (2) Treatment: Admission underwent tumor tissue biopsy or open surgica biopsy, pathologica diagnosis after diagnosis of osteosarcoma, neoadjuvant chemotherapy (2-3 times before surgery, postoperative 4-6 times), chemotherapy program: 2-3 cycles of preoperative and postoperative period 4-6, using AP program: namely doxorubicin (adriamycin) and cisplatin, after the 2-3 cycles of chemotherapy before surgery, in the patients body as circumstances permit conditions downstream, surgery + limb reconstructionsurgery,again4-6cyclesofchemotherapy. (3) Evaluate the efficacy of chemotherapy: After review of laboratory tests before