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目的观察大剂量甲氨喋呤治疗骨肉瘤的不良反应。方法经组织活检病理证实普通型骨肉瘤患者65例,均在术后给予甲氨喋呤联合亚叶酸钙化疗,并给予充分水化、碱化尿液、保肝、止吐等对症、支持治疗,观察不良反应发生情况。结果 65例患者应用大剂量甲氨喋呤化疗4～12个疗程,共化疗364例次,化疗后发生肝功能异常134例次(36.9%)、白细胞计数减少162例次(44.6%)、肾功能异常196例次(53.9%),口腔黏膜炎56例次(15.5%),腹泻28例次(7.7%),其中腹泻患者均合并不同程度口腔黏膜炎。结论在充分水化、碱化尿液等基础上应用大剂量甲氨喋呤联合亚叶酸钙治疗骨肉瘤下可减轻化疗不良反应,腹泻合并不同程度口腔黏膜炎者需适当增加亚叶酸钙应用次数,加强口腔黏膜护理。
Objective To observe the adverse reactions of high dose methotrexate in the treatment of osteosarcoma. Methods Totally 65 patients with common type osteosarcoma were confirmed by histopathological biopsy. Methotrexate and leucovorin were given postoperatively. The patients were treated with hydration, alkalinization of urine, , Observe the occurrence of adverse reactions. Results A total of 654 patients received high-dose methotrexate chemotherapy for 4 to 12 cycles, 364 cycles of chemotherapy, 134 cases (36.9%) of liver dysfunction after chemotherapy, 162 cases (44.6%) of white blood cell count, There were 196 cases (53.9%) of functional abnormalities, 56 cases of oral mucositis (15.5%) and 28 cases of diarrhea (7.7%). All patients with diarrhea had different degrees of oral mucositis. Conclusion The application of large doses of methotrexate combined with leucovorin in the treatment of osteosarcoma on the basis of full hydration and alkalinized urine can reduce the adverse reactions of chemotherapy. Diarrhea with different degrees of oral mucositis need to be appropriately increased folic acid calcium application times , To strengthen oral mucosal care.