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目的探讨射频消融在骨转移癌治疗中的安全性和有效性。方法 2008年11月至2012年12月,我科应用射频消融治疗骨转移癌19例,男10例、女9例,平均年龄57(41~76)岁,原发病灶分别是:肺癌11例,肾癌2例,乳腺癌、甲状腺癌、直肠癌、胃癌、肝癌各1例,原发不明1例。19例共消融21处病灶,病灶分别位于股骨(9处)、骨盆(6处)、肱骨(5处)、胫骨(1处)。手术方法:16处病灶行射频消融后肿瘤刮除,重建骨连续性;另外5处病灶只行经皮射频消融,其中3处股骨干病灶行髓内针固定。术后进行随访,并用疼痛评分及功能评分进行疗效评价、检查有无复发及手术的安全性。评价方法:(1)术前和术后疼痛评分(数字分级法)对比;(2)长期(>6个月)存活患者的功能评定(MSTS评分)。结果平均随访10(1~32)个月。死亡15例,平均存活9.7(1~32)个月,疼痛评分术前平均8.1分,术后1周平均2.2分,术后3个月平均2.7分,术前和术后比较,差异有统计学意义(P<0.01)。对术后存活超过6个月的12例进行功能评定,优良率为83.3%。1例术后6个月消融处再次疼痛,口服止疼药物治疗,11个月后原发病进展死亡。1例术中在止血带处发生热损伤。1例术后皮缘坏死。结论射频消融治疗骨转移癌是一种安全有效的方法,对局部病灶可以缓解疼痛,控制肿瘤进展。
Objective To investigate the safety and effectiveness of radiofrequency ablation in the treatment of bone metastases. Methods From November 2008 to December 2012, 19 patients with bone metastases were treated with radiofrequency catheter ablation. There were 10 males and 9 females, with an average age of 57 (41-76) years. The primary lesions were lung cancer , 2 cases of kidney cancer, 1 case of breast cancer, thyroid cancer, rectal cancer, gastric cancer and liver cancer, 1 case of unknown origin. In 19 cases, 21 lesions were ablated. The lesions were located in femur (9 sites), pelvis (6 sites), humeral site (5 sites) and tibia (1 site) respectively. Surgical methods: Tumors were removed at 16 lesions after radiofrequency ablation, and bone continuity was reconstructed. The other 5 lesions were treated with percutaneous radiofrequency ablation only, and 3 femoral stem lesions were fixed with intramedullary nails. Follow-up was performed after operation, and the pain score and functional score were used to evaluate the curative effect. The recurrence and surgical safety were examined. Methods of evaluation: (1) Preoperative and postoperative pain scores (numerical grading) contrast; (2) Long term (> 6 months) functional assessment of survivors (MSTS score). Results The average follow-up of 10 (1 ~ 32) months. 15 cases died, with an average survival of 9.7 (1 ~ 32) months. The pain scores were 8.1 before surgery, 2.2 after 1 week and 2.7 after 3 months respectively. There were statistically significant differences between preoperative and postoperative Significance (P <0.01). The function of 12 patients who survived for more than 6 months after operation was evaluated. The excellent and good rate was 83.3%. One patient had pain again after 6 months of ablation, oral pain medication, 11 months after the original disease progression death. One case had thermal injury at the tourniquet. 1 case of skin necrosis. Conclusion Radiofrequency ablation is a safe and effective method for the treatment of bone metastases. It can relieve pain and control tumor progression in local lesions.