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目的寻找临床ⅡB期骨恶性肿瘤局部侵袭性的证据,对保肢手术治疗后局部复发和远处转移的原因进行探讨。方法收集31例ⅡB期骨恶性肿瘤病例,对其手术标本行HE染色、细胞外基质金属蛋白酶诱导因子(EMMPRIN)免疫组织化学SABC法染色及碱性磷酸酶染色,了解肿瘤局部侵袭的情况,观察EMMPRIN及碱性磷酸酶在肿瘤组织及周围组织中的表达情况。其中12例手术过程中对血管神经束进行光固化处理。结果发现肿瘤局部侵袭9例,占29%(9/31)。血管内瘤栓共3例,占10%(3/31)。血管壁外肿瘤3例,占10%(3/31)。血管神经束周围的侵袭6例占总侵袭数的67%(6/9)。EMMPRIN阳性染色11例,占35%(11/31)。碱性磷酸酶染色阳性8例,占26%(8/31)。结论ⅡB期骨恶性肿瘤存在局部侵袭性,血管神经束周围的侵袭较为常见,侵袭组EMMPRIN阳性率及碱性磷酸酶阳性率均高于未发现侵袭组。手术过程中对血管神经束进行光固化处理有利于进一步清除肿瘤的局部侵袭,减少术后局部复发和远处转移率。
Objective To find the evidence of clinical invasion of clinical stage ⅡB malignant bone tumor and discuss the reasons of local recurrence and distant metastasis after limb salvage surgery. Methods Totally 31 cases of stage ⅡB malignant bone tumors were collected. The specimens were stained with HE staining, immunohistochemical SABC staining and alkaline phosphatase staining (EMMPRIN) to observe the local tumor invasion. EMMPRIN and alkaline phosphatase expression in tumor tissue and surrounding tissue. Among them, 12 cases of vascular nerve bundles were cured by light during surgery. The results showed that 9 cases of local tumor invasion, accounting for 29% (9/31). A total of 3 cases of intravascular tumor emboli, accounting for 10% (3/31). Three cases of vascular wall tumor, accounting for 10% (3/31). 6 cases of invasion around the vascular fascicles accounted for 67% of the total invasion (6/9). Positive EMMPRIN staining in 11 cases, 35% (11/31). Alkaline phosphatase staining in 8 cases, accounting for 26% (8/31). CONCLUSIONS: Stage IIB malignant tumors are locally aggressive and invasion around the vascular fascicles is more common. The positive rate of EMMPRIN and the positive rate of alkaline phosphatase in invasive group are higher than those in invasive group. During the operation of the vascular bundle for light curing treatment is conducive to further clear the local invasion of the tumor and reduce postoperative local recurrence and distant metastasis rate.