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目的回顾性的分析了应用微波原位灭活技术治疗髋臼周围转移癌的手术方法,观察手术疗效,从而评估微波灭活的安全性及有效性。方法 2006年10月至2012年9月,15例髋臼周围转移癌的患者在我院接受微波原位灭活手术治疗。其中男8例,女7例,年龄36~66岁,中位年龄50岁。原发肿瘤肺癌5例,肝癌、肾癌、乳癌及前列腺癌各2例,甲状腺癌及直肠癌各1例。全部病例均得到明确的术后病理学证实,其中4例以髋臼周围肿瘤为首发表现的病例进行了术前活检。肿瘤累及Ⅰ~Ⅲ区的病例6例,Ⅱ区4例,Ⅱ+Ⅲ区3例,Ⅰ+Ⅱ区2例。髋臼周围转移癌原位微波灭活手术适应证为:临床疼痛症状明显(VAS>7分)且保守治疗无效的病例,或肿瘤累及髋臼顶部负重区存在病理骨折风险的病例,且临床评估预期生存期>6个月者。应用自体骨、异体骨或骨水泥重建骨缺损,骨盆重建钢板固定。结果手术时间平均3.2 h,术中出血平均800 ml。91.7%患者术后疼痛得到满意的缓解。术后MSTS功能评分平均为25分。13例病例得到随访,随访时间6~49个月,平均随访21个月,其中1例肾癌及1例肝癌病例分别在术后8个月及13个月局部复发;5例术后7~22个月死于原发疾病,但没有髋臼周围肿瘤复发;其余6例患者至今存活且没有髋臼周围肿瘤局部复发的证据。无伤口并发症及深部感染的发生,无骨折发生。结论将微波原位灭活技术应用到髋臼周围转移癌的治疗,既可以达到比较满意的肿瘤局部控制,又可以减少手术损伤,保留髋关节功能,是一种值得采用的治疗方法。
OBJECTIVE: To retrospectively analyze the surgical treatment of metastatic carcinoma of the acetabulum by microwave in situ inactivation technique and observe the curative effect of the operation to assess the safety and effectiveness of microwave inactivation. Methods From October 2006 to September 2012, 15 patients with metastatic carcinoma around the acetabulum underwent microwave in situ inactivation in our hospital. Including 8 males and 7 females, aged 36 to 66 years old, the median age of 50 years. Primary tumor lung cancer in 5 cases, liver cancer, kidney cancer, breast cancer and prostate cancer in 2 cases, thyroid cancer and rectal cancer in 1 case. All cases were confirmed by postoperative pathology confirmed, of which 4 cases of acetabular tumors as the first manifestation of cases performed preoperative biopsy. 6 cases were involved in grade Ⅰ ~ Ⅲ tumors, 4 in grade Ⅱ, 3 in grade Ⅱ + Ⅲ and 2 in grade Ⅰ + Ⅱ. Indications of in-situ microwave inactivation of metastatic carcinoma around the acetabulum are clinically significant (VAS> 7) clinically significant and ineffective conservative treatment, or tumor involvement in the risk of pathological fracture at the top of the acetabular component Expected survival of> 6 months. Application of autologous bone, allogeneic bone or bone cement reconstruction of bone defects, pelvic reconstruction plate fixation. Results The average operation time was 3.2 h and the intraoperative bleeding was 800 ml. 91.7% of patients with satisfactory pain relief. Postoperative MSTS score was 25 on average. Thirteen cases were followed up for 6 to 49 months with an average follow-up of 21 months. One case of RCC and one case of HCC were locally recurred at 8 months and 13 months respectively. 22 months died of primary disease, but no recurrence of acetabulum around the tumor; the remaining 6 patients have survived to date and there is no evidence of local recurrence of acetabular tumors. No wound complications and deep infection occurred, no fracture occurred. Conclusion The application of microwave in-situ inactivation technique in the treatment of metastatic carcinoma of the acetabulum can not only achieve satisfactory local tumor control, but also reduce the surgical injury and retain the function of the hip joint, which is a worthy treatment method.