术中微波原位加热与辅助化疗治疗恶性骨肿瘤的随诊报告

四肢骨肿瘤保肢手术各有其优缺点。为探讨新的治疗方法，１９８０年７月～１９９４年１２月，作者对２５例骨肿瘤患者进行了微波原位加热与辅助化疗的综合治疗。其中男１５例，女１０例。年龄：１０～４６岁，平均２５．８岁。肿瘤部位：股骨下端１６例，胫骨上端５例，股骨干２例，髂骨２例。肿瘤类型：骨肉瘤１６例，皮质旁骨肉瘤４例，软骨肉瘤３例，平滑肌肉瘤２例；肿瘤分期：Ⅱｂ１７例，Ⅱａ５例，Ⅲｂ３例。加热温度５０℃，持续时间１５分钟，分野照射，多点测温。本组２５例术后平均随访５７个月。５年生存率为７０．４９％，１０年生存率为５４．８３％。术后２１例综合功能（Ｅｎｎｅｋｉｎｇ标准）＞１５分。结果提示本方法无需截骨和内固定，可以准确控制温度和时间，对骨组织损伤小，有利于术后骨组织重建，远期并发症少，手术操作简单，推广性强。

Microwave heating and neoadjuvant chemotherapy for malignant bone tumor

Limb salvage is widely used but has different disadvantages. Attempting to establish a new limb conservative procedure, we treate patients with malignant bone tumor by intraoperative microwave heating on tumor bearing bone in place and neoadjvant chemotherapy. The tumors were localized at distal femur in 16, proximal tibia in 5, femur shaft in 2, and illia in 2. Pathological diagnosis showed osteosarcoma in 16 patents, parosteoal osteosarcoma in 4, chondrosarcoma in 3, and leiomyosarcoma in 2. The stage of tumor was II b in 18 patients, II a in 6, and III b in 3. Operative technique was wide resection for tumor in soft tissue, protecting the surrounding tissue from heat injury by copper net, and cheating tumor bone at 50 C for 15 minutes. Follow-up varied from 4 to 180 months (mean 57 months). The 5-, 10-years surviral rates were 70.19% and 54.83% respectively. Functional results of 21 patients were > 15 points by Enneking system. The advantages of the method and keeping the shape and continuity of the tumor bearing bone without osteotomy and internal fixation, controlling the time and temperature of heating treatment easily, benefiting for bone remodeling of heated bone. The indications, complications, and surgical procedure of this method were discussed in detail.