射频消融在骨转移癌姑息治疗中的应用

目的：探讨射频消融在骨转移癌治疗中的安全性和有效性。方法2008年11月至2012年12月，我科应用射频消融治疗骨转移癌19例，男10例、女9例，平均年龄57（41～76）岁，原发病灶分别是：肺癌11例，肾癌2例，乳腺癌、甲状腺癌、直肠癌、胃癌、肝癌各1例，原发不明1例。19例共消融21处病灶，病灶分别位于股骨（9处）、骨盆（6处）、肱骨（5处）、胫骨（1处）。手术方法：16处病灶行射频消融后肿瘤刮除，重建骨连续性；另外5处病灶只行经皮射频消融，其中3处股骨干病灶行髓内针固定。术后进行随访，并用疼痛评分及功能评分进行疗效评价、检查有无复发及手术的安全性。评价方法：（1）术前和术后疼痛评分（数字分级法）对比；（2）长期（＞6个月）存活患者的功能评定（MSTS评分）。结果平均随访10（1～32）个月。死亡15例，平均存活9.7（1～32）个月，疼痛评分术前平均8.1分，术后1周平均2.2分，术后3个月平均2.7分，术前和术后比较，差异有统计学意义（P＜0.01）。对术后存活超过6个月的12例进行功能评定，优良率为83.3%。1例术后6个月消融处再次疼痛，口服止疼药物治疗，11个月后原发病进展死亡。1例术中在止血带处发生热损伤。1例术后皮缘坏死。结论射频消融治疗骨转移癌是一种安全有效的方法，对局部病灶可以缓解疼痛，控制肿瘤进展。

A application of radiofrequency ablation in the palliative treatment of bone metastases

Objective To investigate the safety and effectiveness of radiofrequency ablation （ RFA ） in the treatment of bone metastases. Methods From November 2008 to December 2012, 19 patients with bone metastases were treated with RFA in our department. There were 10 males and 9 females with an average age of 57 years old （ range;41-76 years ）. Lung carcinoma was the most common primary tumor （ n=11 ）, followed by kidney carcinoma （ n=2 ）, breast carcinoma （ n=1 ）, thyroid carcinoma （ n=1 ）, rectal carcinoma （ n=1 ）, gastric carcinoma （ n=1 ）, hepatocellular carcinoma （ n=1 ） and unknown carcinoma （ n=1 ）. There were totally 21 lesions in the 19 patients, including 9 lesions in the femur, 6 lesions in the pelvis, 5 lesions in the humerus and 1 lesion in the tibia. Curettage and reconstruction after the RFA were performed for 16 lesions. Percutaneous RFA was performed for 5 lesions, and 3 of them in the femoral shaft were ifxed with intramedullary nails. During the follow-up, the pain scores and function scores were used to evaluate the effects and check the recurrence and the safety of the surgery. There were 2 kinds of evaluation methods. （ 1 ） The preoperative and postoperative pain scores were compared （ numerical rating scale ）. （ 2 ） The function evaluation of the patients whose survival time was more than 6 months was performed （ the Musculoskeletal Tumor Society MSTS rating scale ）. Results The mean follow-up period was 10 months （range;1-32 months ） and the mean survival time was 9.7 months （ range;1-32 months ）. Fifteen patients were dead. The mean pain score was 8.1 points before the surgery and 2.2 points and 2.7 points at 1 week and 3 months after the surgery respectively, and there were statistically signiifcant differences before and after the surgery （ P＆lt;0.01 ）. Local pain recurred in 1 patient at 6 months after the ablation with the pain score of 7 points, who received oral analgesic but died 11 months later due to the progress of primary tumors. One patient had thermal damage around the skin adjacent to the tourniquet during the surgery and 1 patient developed wound necrosis after the surgery. The function evaluation was performed in 12 patients whose survival time was more than 6 months, and the excellent and good rate was 83.3%. Conclusions The RFA is a safe and effective approach in the palliative treatment of bone metastases. The local pain can be relieved and the development of bone metastases can be controlled.