骨与软组织恶性肿瘤的介入综合治疗 ——影像学诊断与影响疗效因素研究

目的探讨骨与软组织恶性肿瘤影像学诊断和介入综合治疗方法选择、疗效和预后。方法58例经骨穿活检或手术病理证实的骨与软组织恶性肿瘤,全部经肿瘤局部供血动脉灌注化疗或超选择肿瘤血管栓塞,随访4个月至12年,局部灌注化疗19例,超选择肿瘤血管术前栓塞8例,灌注化疗加超选择肿瘤血管栓塞31例;共行介入治疗78疗次。结果影像学诊断与病理结果符合率为70.73%;介入治疗后近期临床改善80.65%,保肢率为73%;局部灌注加栓塞在疗效上优于局部单纯化疗灌注(P<0.05)。结合手术瘤骨切除、瘤骨灭活或截肢以及免疫增强等综合治疗,2年生存率73.2%。结论骨与软组织恶性肿瘤的早期诊断、早期局部介入治疗结合手术等综合治疗对增加保肢率,改善生活质量,提高5年生存率具有重要意义,是值得探索和完善的治疗方法。

Study of imaging diagnosis and interventional synthetic therapy for bone and soft tissue sarcoma

Objective To study the radiographic findings, effect and prognosis of interventional therapy (IVT) for bone and soft tissue sarcoma. Methods Fifty-eight patients confirmed by pathological examination or bone biopsy punctune, which treated by local transarterial infusion (TAI) chemotherapy or/and transarterial embolization (TAE) before surgery were followed up from 4 months to 12 years. There were 19 patients using simple local infusion and 8 patients performing superselective embolized tumor vessels before surgery and 31 patients were both done. Results The percentage of agreement between imaging diagnosis and pathological result was 70.73 %, the rate of clinical improvement after IVT in short-term was 80.65%, limb salvage rate was 73 %, the effect of local infusion plus embolization surpassed simple chemotherapy infusion (P<0.05), the survival rate was 73.2% during 2 years. Conclusion The synthetic therapy of IVT combine with surgery for bone and soft tissue sarcoma was obviously improved, this improvement has favorable value in enhancement the limb salvage rate, the quality of life and the survival rate in 5 years.