资源描述：
《高危骨肉瘤的临床特点及治疗对策》由会员上传分享，免费在线阅读，更多相关内容在工程资料-天天文库。
1、高危骨肉瘤的临床特点及治疗对策作者：王臻黄耀添黄鲁豫赵金康于会东刘继中杜晓川李敬帮晏培松王志祥【关键词】骨肉瘤关键词：骨肉瘤;危重病;综合治疗摘要：目的通过分析61例骨肉瘤预后因素及生存率，探讨高危骨肉瘤临床特点及治疗对策，报告16例高危骨肉瘤治疗经验.方法以经肢体挽救手术治疗有完整随访资料的61例骨肉瘤为基础，寿命表法计算生存率，采用图像分析技术对肿瘤预后相关因素包括肿瘤的绝对长度、绝对宽度、绝对深度、绝对面积、软组织肿块最大横径进行分析.结果61例骨肉瘤随访1〜10a,5a生存率57.5%,外科分期III期;骨肉瘤与宿主骨面积比±2/3;软组织肿块最大横径26cm;病理骨折;
2、活检标本PCNA阳性细胞检出占平均视野2/3以上均属高危骨肉瘤•采用术前多次化疗，深静脉持续给药；高选择骨肉瘤原发灶和转移灶滋养动脉化疗并栓塞;术前放疗和肢体挽救术处理高危骨肉瘤16例，随访1.5a,死亡2例，带病存活5例，无病存活9例，保肢率68.7%.结论本研究使一些高危骨肉瘤得到了积极救治，更具备综合性和肿瘤针对性.Abstract:ATMWediscussedthecharacter!stiesandtreat-mentofhigh-riskosteosarcomabyanalyzingprognosticfactorandsurvivalrateof61osteosar
3、comapatients,andreportedsomeexperienee.METHODSDependingon61osteosarco-mapatientswhoundertooklimb-salvageoperationandhadintegrityfollowing-updata,weadoptedimageanalyzingtech-nologytoprocesstheprognosticfactors,whichincludedab-solutetumorlengthswidth,depth,areaandmaximumtrans-versediameter.RESU
4、LTS61osteosarcomacaseshadbeenfollowedupforlOyears.Five-yearsurvivalratewas57.5%.ThehighriskfactorsincludedIIIsurgerystage,higherthan2/3arearatioofsarcomatohostbone,morethan6centime-tersmaximumtransversediameter,pathologicalfracture,andhigherthan2/3positiveareapersightscopeofPCNAinbiopsyspecim
5、en.Thenweundertookrepeatedpre~operationchemotherapy,highselectivearteryembolismandchemotherapy,andsalvageproceduresforl6highriskos-teosarcomapatients,therewere2death,5survivalwithtu~morand9non-tumorsurvivalafterl8monthsfollowing-up,andthesuccessfulsalvageratewas68・7%.CONCLUSIONOurresearchlead
6、stheactivetreatmenttohighriskos-teosarcoma,aimsdirectlyattheosteosarcomaandprovidescomprehensivetreatmentproject.o引言骨倘瘤的预后判断和临床诊治一直是骨肿瘤领域中的难点和重点，虽然目前探讨的方法很多，但仍没冇在实用性和冇效性之间找到平衡，我们依据木科室大量临床实践和实验资料进行了有益的探讨.1对象和方法1.1对象我科1987-05/1996-12行肢体挽救手术治疗的冇完整随访记录的骨肉瘤患者61例.1.2方法计算机图像分析X线片:①肿瘤绝对长度(absolutetum
7、orlength,ATL):测量肿瘤最大纵径(X线片正、侧位)；②肿瘤绝对宽度(absolutetu-morwidth,ATW):正位X线片肿瘤宽度;③肿瘤绝对深度(absolutetumordepth,ATD):侧位X线片肿瘤最大横径;④肿瘤绝对面积(absolutetumorplane,ATP)A=abnATLXATW(ATD)X0.79[1];⑤软组织肿块最大横径•患者均经术前术后化疗，绝大部分接受免疫治疗(具体方案见Figi).图1骨肉瘤化疗及免疫治疗方案略2结果2.1随
