儿童骨肉瘤患者保留骨骺的灭活再植术(英文)

目的探讨在有效大剂量化疗前提下的保留骨骺灭活再植术的可行性。方法自1999年开始在 MMIA 方案(由甲氨喋呤、异环磷酰胺、阿霉素组成)的有效大剂量化疗保护下对2例儿童骨肉瘤患者行保留骨骺的灭活再植术。术前严格遵循新辅助化疗的原则,行2个疗程的 MMIA 化疗。化疗后患者疼痛消失,肿块缩小,AKP、LDH明显下降,X 线片及 MR 示左股骨下端病变局限,边缘清晰,硬化及骨化明显,骨骺未受侵蚀。术后继续应用2疗程化疗。结果 2例患者术后切口均一期愈合。随访分别为3年和4年,无复发和转移,肢体功能恢复理想。结论保留骨骺的灭活再植术是治疗儿童骨肉瘤的一种新方法,其在不增加局部复发率的前提下避免术后双侧肢体不等长,并改善了术后患者的肢体功能。但严格掌握手术适应证是至关重要的,否则将导致灾难性后果。

Inactivated Bone Replantation with Preservation of the Epiphysis in Children with Osteosarcoma: Clinical Report of Two Cases

Objective:To evaluate the value of inactivated bone replantation with preservation of the epi- physis following the effective chemotherapy in avoiding postoperative discrepancy of the affected limb in children with osteosarcoma.Methods:Two children (aged 5 and 10 years,1 male and 1 female) with osteosarcoma underwent inactivated bone replantation with preserving epiphysis following chemotherapy (MMIA protocol,including high-dose methotrexate,adriamycin and ifosfamide).After two cycles of preop- erative chemotherapy,pain vanished,the local mass shrank and there was no pain on pressing the affected parts.Sera AKP and LDH were reduced to normal levels;marked shrinkage and sclerotic changes and good margin of lesions were seen on plain radiographs and MR images.Two courses of the same proto- col as preoperative chemotherapy were administered postoperatively.Results:Postoperative histological examination of the specimens demonstrated absence of vital tumor cells.Incisions healed well and no complications occurred.The replanted inactivated bone healed with host at 6 months after operation. In the two patients,no evidence was seen of metastasis and recurrence and discrepancy of the affected limbs in postoperative 36 and 48 months.Functions of the affected limbs were satisfactory.Conclusion: Inactivated bone replantation with preserving epiphysis was a viable option for osteosarcoma in children. The long-term outcomes remain to be further proven.