[骨盆原发性恶性骨肿瘤的外科治疗]

Ding Yi, Niu Xiao-hui, Zhang Qing, Ma Ke, Liu Wei-feng

Department of Orthopaedic Oncology, Beijing Jishuitan Hospital, Beijing 100035, China.

Zhonghua Wai Ke Za Zhi. 2008 Jun 15;46(12):886-90.

OBJECTIVE

To evaluate the surgical treatment effect of primary malignant pelvic bone tumors.

METHODS

Retrospective study was carried out in 79 patients with primary malignant pelvic bone tumors treated surgically and followed up regularly between October 1992 and July 2007. In this cohort, 23 tumors were low-grade malignant of I B, and 56 tumors were high-grade malignant of II B. According to the preoperative diagnosis and the effect of chemotherapy, different methods of tumor resection and reconstruction were applied respectively. Surgical specimens were evaluated postoperatively for the surgical margins in accordance with Enneking's criteria. Functional results were assessed by MSTS system during follow-up. The mean time of follow-up was 28.6 months (range, 0-183 months). The minimum follow-up time in survival patients was 4 months.

RESULTS

Seventy limb-salvage surgeries including 28 reconstructions, and 9 hemipelvectomy were carried out. In limb-salvage group, the mean MSTS functional scores both were 15 points for patients with (range, 5-29 points) or without (range, 2-30 points) reconstructions. The overall local recurrence rate was 31.6% (25/79). Statistical difference (P = 0.023) of local recurrence rate was seen between low-grade (13.0%) and high-grade (39.3%) groups. While, there was no difference (P = 0.620) between limb-salvage group (30.0%) and hemipelvectomy group (44.4%). Significant difference (P = 0.014) in local recurrence rate was found between inadequate surgical margin (intralesional and marginal margin) group (38.1%) and adequate surgical margin (wide margin) group (6.3%). In 14 patients developed postoperative distant metastasis, 12 in local recurrence group which incidence was 48.0%, compared to 2 in no-recurrence group which incidence was 3.7%, and the difference was significant (P = 0.000). The overall survival rate was 70.9%.

CONCLUSIONS

Wide surgical margin is essential for successful resection of primary malignant pelvic bone tumors. How to choose and improve functional reconstruction is the focus of work in the future.

目的

评估原发性恶性骨盆骨肿瘤的手术治疗效果。

方法

对1992年10月至2007年7月间接受手术治疗并定期随访的79例原发性恶性骨盆骨肿瘤患者进行回顾性研究。该队列中，23例肿瘤为ⅠB期低级别恶性，56例肿瘤为ⅡB期高级别恶性。根据术前诊断及化疗效果，分别采用不同的肿瘤切除及重建方法。术后依据Enneking标准对手术标本的手术切缘进行评估。随访期间采用MSTS系统评估功能结果。平均随访时间为28.6个月（范围0 - 183个月）。生存患者的最短随访时间为4个月。

结果

实施了70例保肢手术，其中包括28例重建手术，9例半骨盆切除术。在保肢组中，接受（范围5 - 29分）或未接受（范围2 - 30分）重建手术的患者MSTS功能评分均值均为15分。总体局部复发率为31.6%（25/79）。低级别（13.0%）和高级别（39.3%）组之间局部复发率存在统计学差异（P = 0.023）。然而，保肢组（30.0%）和半骨盆切除术组（44.4%）之间无差异（P = 0.620）。手术切缘不充分（囊内和边缘切缘）组（38.1%）和手术切缘充分（广泛切缘）组（6.3%）之间局部复发率存在显著差异（P = 0.014）。14例患者发生术后远处转移，其中12例在局部复发组，发生率为48.0%，相比之下，无复发组为2例，发生率为3.7%，差异有统计学意义（P = 0.000）。总体生存率为70.9%。