Makhson A N
Khirurgiia (Mosk). 1992 Jul-Aug(7-8):59-63.
The article deals with the results of operations applied in the system of complex treatment of 83 patients (86 operations) with metastases of malignant tumours in the skeletal bones. Fourteen patient had carcinoma of the lung, 23--carcinoma of the breast, 28--carcinoma of the kidney, 8--carcinoma of the thyroid gland, and 10 patients had other malignant tumors. Operative interventions in the form of resection of the articular end or total removal of a tubular bone with endoprosthesis in affection of a long tubular bone and its pathological fracture or the threat of such fracture were substantiated. In the presence of special indications, osteosynthesis of the pathological fracture or amputation (exarticulation) of the limb may be undertaken. Laminectomy is indicated in metastatic lesion of the spine with the development of neurological disorders. Four (5%) patients died in the postoperative period. Average survival in the group of patients was 35 months, in the separate groups it was as follows: lung carcinoma metastases--9 months, kidney carcinoma metastases--31 months, thyroid carcinoma metastases--37 months, breast carcinoma metastases--40 months, metastases of other forms of malignant tumors--30 months. Longest survival--7.5 years. Average value of life quality according to Karnovsky was 30% before operation and 67% after it.
本文探讨了对83例(86次手术)骨骼出现恶性肿瘤转移患者进行综合治疗时所采用手术的结果。其中14例为肺癌患者,23例为乳腺癌患者,28例为肾癌患者,8例为甲状腺癌患者,10例为其他恶性肿瘤患者。对于长管状骨及其病理性骨折或有此类骨折风险的病变,以切除关节端或用假体完全切除管状骨的形式进行手术干预是合理的。在有特殊指征的情况下,可对病理性骨折进行骨固定或对肢体进行截肢(关节离断)。对于出现神经功能障碍的脊柱转移性病变,可行椎板切除术。4例(5%)患者在术后死亡。患者组的平均生存期为35个月,各分组情况如下:肺癌转移患者为9个月,肾癌转移患者为31个月,甲状腺癌转移患者为37个月,乳腺癌转移患者为40个月,其他形式恶性肿瘤转移患者为30个月。最长生存期为7.5年。根据卡氏评分,术前生活质量平均评分为30%,术后为67%。