Divisi D, Gizzonio D, Crisci R
Department of Thoracic Surgery, University of L'Aquila, G. Mazzini Hospital, Circonvallazione Ragusa 39, 64100 Teramo, Italy.
Thorac Cardiovasc Surg. 2006 Aug;54(5):328-31. doi: 10.1055/s-2006-923918.
The diagnostic procedures, role of surgery and multimodal treatment for osteosarcoma pulmonary metastases are examined.
From January 2000 to June 2005, we observed 35 patients with osteogenic repetitions. Patients were studied by total-body computerised tomography (CT) and by thoracic single-photon emission computerised tomography (SPECT). Preoperative histological diagnosis was obtained by CT-guided transthoracic needle biopsy (23 cases) and fibre-optic bronchoscopy (12 cases).
Four lower, 6 upper and 2 middle lobectomies were carried out using a thoracotomy approach. Video-assisted thoracoscopy was used in the other 23 patients who underwent 36 wedge resections. CT showed a sensitivity of 86 % and a specificity of 66 %; SPECT had a sensitivity of 80 % and a specificity of 100 %. Twenty-five patients are still living 25 +/- 11 months after the intervention.
SPECT was demonstrated to offer a better result in the individualisation of secondary pulmonary nodules after primary osteosarcoma. The excision of all resectable lung metastases, integrated in a multidisciplinary strategy, offers good results in terms of survival.
探讨骨肉瘤肺转移的诊断方法、手术作用及多模式治疗。
2000年1月至2005年6月，我们观察了35例骨肉瘤患者。患者接受全身计算机断层扫描（CT）和胸部单光子发射计算机断层扫描（SPECT）检查。术前组织学诊断通过CT引导下经胸针吸活检（23例）和纤维支气管镜检查（12例）获得。
采用开胸手术进行了4例下叶、6例上叶和2例中叶切除术。另外23例患者采用电视辅助胸腔镜手术，进行了36例楔形切除术。CT显示敏感性为86%，特异性为66%；SPECT的敏感性为80%，特异性为100%。25例患者在干预后25±11个月仍存活。
SPECT在原发性骨肉瘤继发肺结节的个体化诊断中显示出更好的结果。将所有可切除的肺转移灶切除，并纳入多学科策略，在生存方面可取得良好效果。
