微波原位灭活技术治疗髋臼周围骨转移癌

目的回顾性的分析了应用微波原位灭活技术治疗髋臼周围转移癌的手术方法，观察手术疗效，从而评估微波灭活的安全性及有效性。方法2006年10月至2012年9月，15例髋臼周围转移癌的患者在我院接受微波原位灭活手术治疗。其中男8例，女7例，年龄36～66岁，中位年龄50岁。原发肿瘤肺癌5例，肝癌、肾癌、乳癌及前列腺癌各2例，甲状腺癌及直肠癌各1例。全部病例均得到明确的术后病理学证实，其中4例以髋臼周围肿瘤为首发表现的病例进行了术前活检。肿瘤累及 I～III 区的病例6例， II 区4例，II＋III 区3例，I＋II 区2例。髋臼周围转移癌原位微波灭活手术适应证为：临床疼痛症状明显（ VAS ＞7分）且保守治疗无效的病例，或肿瘤累及髋臼顶部负重区存在病理骨折风险的病例，且临床评估预期生存期＞6个月者。应用自体骨、异体骨或骨水泥重建骨缺损，骨盆重建钢板固定。结果手术时间平均3.2 h，术中出血平均800 ml。91.7%患者术后疼痛得到满意的缓解。术后 MSTS 功能评分平均为25分。13例病例得到随访，随访时间6～49个月，平均随访21个月，其中1例肾癌及1例肝癌病例分别在术后8个月及13个月局部复发；5例术后7～22个月死于原发疾病，但没有髋臼周围肿瘤复发；其余6例患者至今存活且没有髋臼周围肿瘤局部复发的证据。无伤口并发症及深部感染的发生，无骨折发生。结论将微波原位灭活技术应用到髋臼周围转移癌的治疗，既可以达到比较满意的肿瘤局部控制，又可以减少手术损伤，保留髋关节功能，是一种值得采用的治疗方法。

In sitn microwave ablation in the treatment of periacetabular metastases

Objective To evaluate the safety and efficiency of in sire microwave ablation in the treatment of periacetabular metastases and observe surgical outcomes retrospectively. Methods From October 2006 to September 2012, 15 patients with periacetabular metastases had undergone surgery using in situ microwave ablation in our hospital. There were 8 males and 7 females, the age ranged from 36 years to 66 years with the median age of 50 years. The primary tumors were lung cancer in 5, liver cancer, renal cancer, breast cancer and prostate cancer in 2 respectively, thyroid cancer and rectal cancer in 1 respectively. All cases were confirmed pathologically in which 4 cases were verified through preoperative biopsy whose primary lesion was found around acetabulum. For locations, there were 6 cases in zone I-III, 4 in zone II, 3 in zone II＋III and 2 in zone I＋II. The indications of in situ microwave ablation for periacetabular metastases were severe pain （ visual analogue scale 〉7 ） which could not be relieved with conservative treatments, or the top acetabulum was involved with risk of pathological fracture and the estimated lifetime would be more than 6 months. Bone defects were reconstructed using autograft, allograft or bone cement with or without plate fixation. Results The average operating time was 3.2 hours and the average volume of bleeding was 800 ml. Satisfied pain relief was archived in 91.7% of all patients. The average postoperative musculoskeletal tumor society （ MSTS ） functional score was 25 points. 13 patients were followed up for 6-49 months with the average of 21 months. One renal cancer and one liver cancer relapsed 8 months and 13 months after surgery respectively. 5 patients died from primary cancer 7-22 months after the surgery with no local recurrences. The other 6 patients are alive so far with no evidence of local recurrence of periacetabular metastases. No wound complication or deep infection was found. No fraction occurred. Conclusions Good local control of tumors, less invasion in operation and sustained joint function have been archived through the application of situ microwave ablation in the treatment of periacetabular metastases, providing an available procedure.