骨的恶性纤维组织细胞瘤诊治分析.doc

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1、骨的恶性纤维组织细胞瘤诊治分析作者：千建荣　李建民　谢飞彬　杨志平　李昕【摘要】　　［目的］探讨骨的恶性纤维组织细胞瘤的临床特点、诊断及治疗方法。［方法］回顾性分析52例骨的恶性纤维组织细胞瘤患者的临床资料，包括发病部位、术前影像学检查、穿刺活检、肿瘤外科分期、治疗方法以及随访结果等。［结果］52例患者肿瘤位于膝关节周围32例、肩关节周围14例、股骨近端3例，跟骨、腰椎、髂骨各1例。术前常规行X线片、CT及MRI，并行穿刺活检。根据Enneking肿瘤外科分期，20例属于ⅡA期，32例属于ⅡB期。所有病例除1例保守治疗外，其余均行手术治疗，以保肢术为主，保肢率74.5％（38／51），同时进

2、行术前、术后化疗及术后放疗。36例患者经过长期随访，随访率69.2％（36／52），其中局部复发9例，远处转移6例，5年生存率61.1％（22／36）。［结论］术前穿刺活检结合影像学检查对恶性纤维组织细胞瘤的诊断有很大帮助，治疗以保肢手术为主，术前、术后化疗以及术后放疗可以防止肿瘤复发，肿瘤的彻底切除是骨的恶性纤维组织细胞瘤治愈的关键。【关键词】骨的恶性纤维组织细胞瘤　保肢术　放疗　化疗　　Diagnosisandtreatmentofmalignantfibroushistiocytomaofbone　　Abstract：［Objective］Toapproachtheclinicalch

3、aracteristic,diagnosisandmethodoftreatmentofmalignantfibroushistiocytomaofbone.［Method］Theclinicaldataof52patientsofmalignantfibroushistiocytomaofbonewereanalyzedretrospectively,includingsitesoftumor,preoperativeimageology,puncturingbiopsy,surgicalstagingoftumor,methodsoftreatment,resultsoffollowu

4、p,andsoon.［Result］Inall52casesofmalignantfibrousbistiocytomaofbone,32caseswereinperipheryofkneejoint,14casesinperipheryofshoulderjoint,3casesintheproximalfemur,1caseincalcaneus,1caseinlumbarand1caseinilium.Thepreoperativeimageelogyandpuncturingbiopsyweremadeasusual.Therewere20casesinstagingofⅡAand3

5、2casesininstagingofⅡBaccordingtoEnnekingssurgicalstagingoftumor.Allcaseswereperformedoperationexceptof1case.Theoperationweremadesalvagelimbmosflyandtheratiooflimbsalvagewas74.5%（38/51）.Thepreoperativeandpostoperativechemotherapyandradiotherapywereperformedatthesametime.Thirtysixofallcaseswereinlo

6、ngtimefollowupandtheratiooffollowupwas69.2%（36/52）.Ninecaseswererecurredintheregion,6caseshaddistantmetastasisandsurvivalrateof5yearswas61.1%（22/36）.［Conclusion］Preoperativepuncturingbiopsyandimageologycanhelpthediagnosisofmalignantfibroushistiocytomaofbone.Surgeryistheprimarymethodandradiothera

7、py6andchemotherapycanpreventtherecurrenceofthetumor.Theresectionofthetumorthoroughisthekeypointofhealingofmalignantfibroushistiocytomaofbone.　　Keywords：malignantfibroushistiocytomaofbone;limbsalvageoperatio