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目的评价微波消融术治疗骨肉瘤的中期疗效,探讨瘤段骨的病理学转归。方法对1例股骨远端骨肉瘤,患者进行了原位微波消融+内固定保肢治疗,术后随访43个月。末次随访时,拆除内固定,术中取股骨(原瘤段骨)中部、远端骨质及其周围软组织进行病理检查。结果该患者手术后53个月无瘤生存,肢体功能MTST评分30分。组织病理提示:瘤段骨中部见少量板层骨小梁、脂肪组织及再生的血管组织;瘤段骨远端骨质可见部分退变坏死及新生骨组织;股骨远端周围软组织镜下可见退变的横纹肌组织、胶原化的纤维结缔组织和神经组织。所有镜下均未见肿瘤细胞。结论该例接受微波消融治疗骨肉瘤患者的中期无瘤生存;术后43个月,原瘤段骨中仍有死骨存在,再血管化没有全部完成,仍有再骨折风险。
Objective To evaluate the medium-term curative effect of microwave ablation in the treatment of osteosarcoma and to explore the pathological changes of the tumor. Methods One case of osteosarcoma distal to femur was treated with in situ microwave ablation and internal fixation of limb salvage. The patients were followed up for 43 months. At the final follow-up, the internal fixation was removed, and the middle of the femur (the tumor segment bone), the distal bone and the surrounding soft tissues were removed for pathological examination. Results The patient survived 53 months after surgery and the limb functional MTST score was 30 points. Histopathology suggests that a small amount of trabecular bone, adipose tissue, and regenerated vascular tissue are seen in the middle of the tumor segment. Partial degeneration, necrosis and new bone tissue can be seen in the distal bone of the tumor segment. Soft tissue microscopy can be seen in the distal femur Variant striated muscle tissue, collagen fibrosis connective tissue and nerve tissue. No tumor cells were seen under all microscopes. Conclusion This case received medium-term tumor-free survival in patients with osteosarcoma treated with microwave ablation. At 43 months after operation, there was still sequestrum in the tumor segment, and no revascularization was completed. There was still a risk of further fracture.