原位微波消融在侵及骨组织的软组织肿瘤保肢手术中的初步应用

目的探讨原位微波消融技术在侵及骨组织的软组织肿瘤保肢手术中的应用价值。方法对2009年3月-2011年8月收治的10例侵及骨组织的恶性或交界性软组织肿瘤患者结合原位微波消融技术进行保肢手术,术后3个月按骨与软组织肿瘤协会（Musculoskeletal Tumor Society,MSTS）评分评估术后肢体功能,观察随访期间局部复发及周身转移情况。结果 10例病例全部获得随访,平均随访时间8.9个月（3～25个月）。保肢手术全部成功,MSTS评分上肢1例27分,下肢9例平均25分（16～30分）。优良率为90%。术后3、17个月局部复发各1例,肺部转移2例。其中1例复发伴肺转移患者截肢术后3个月死亡,余2例末次随访时均带瘤生存。结论在严格掌握手术适应证的基础上对侵及骨组织的软组织肿瘤施行结合原位微波消融技术的保肢手术,可以在未增加复发率的情况下降低手术操作难度,提高成功率,初步临床效果满意。

The initial application of microwave ablation in situ in limb salvage surgery for soft tissue tumors with bone invasion

Objective To evaluate the clinical value of microwave ablation in situ technology in the limb salvage surgery for soft tissue tumors with bone invasion. Methods From March 2009 to August 2011, 10 cases of malignant or boundary soft tissue tumors with bone invasion were treated by limb salvage surgery combined with microwave ablation in situ. According to Musculoskeletal Tumor Society （MSTS） scores, postoperative limb functions were evaluated 3 months after the surgery, local recurrence and metastasis conditions were observed during the follow-up. Results Ten cases were followed up from 3 to 25 months （an average of 8.9 months）. Limb salvage surgery in all patients were successful. MSTS score of upper limb （1 case） was 27, and the average score of lower limb （9 cases） was 25 （from 16 to 30）. The excellent and good rate was 90%. There were local recurrence in 1 case at 3 months and 1 case at 17 months after surgery, and lung metastasis occurred in 2 cases. One case who complicated with lung metastasis died at 3 months after the amputation for recurrent tumor, the other 2 cases survived with tumors at the latest follow-up. Conclusions Based on strict control of surgical indications, combination of microwave ablation in situ and limb salvage surgery could reduce surgical difficulty, improve success rate and obtain primary satisfactory results without increasing the recurrence rate.