CAJ | 학술논문

目的探讨以异环磷酰胺、阿霉素+顺铂的序贯化疗方案加肿瘤精确切除重建对儿童骨盆尤文肉瘤的治疗效果,并评估手术治疗对儿童骨骼生长发育的影响.方法回顾性分析第四军医大学西京医院骨肿瘤科2001年1月至2010年10月收治的10例儿童骨盆尤文肉瘤患者的临床和随访资料,所有患者术前均采用新辅助化疗,行手术切除重建并辅以术后化放疗.化疗采用异环磷酰胺、阿霉素+顺铂方案.采用传统切除重建手术5例,采用计算机辅助进行肿瘤精确切除5例,骨盆重建时适当降低患侧髋关节旋转中心.结果新辅助化疗后,完全缓解1例,部分缓解8例,稳定1例.手术后肢体功能评分为优4例,良好4例,一般1例,差1例.使用导航计算机技术辅助治疗的5例患者肿瘤切除完整,内固定位置准确,未出现局部复发.全组患者均无严重并发症的发生.平均随访37.8个月,10例患者全部生存,但有1例患者术后2年出现肺转移.全组有8例患者的骨骼生长发育未出现明显影响,有1例患者出现髋关节旋转中心失平衡,有1例患者出现代偿性脊柱侧弯.结论以新辅助化疗、手术切除重建、术后化放疗联合治疗儿童骨盆尤文肉瘤的疗效较好;计算机导航辅助技术为儿童骨盆肿瘤的精确切除与重建提供了新的、有效的解决途径;儿童髋臼Y形软骨骺板可能是尤文肉瘤局部侵袭的天然屏障.
목적 탐토이이배린선알、아매소+순박적서관화료방안가종류정학절제중건대인동골분우문육류적치료효과,병평고수술치료대인동골격생장발육적영향.방법 회고성분석제사군의대학서경의원골종류과2001년1월지2010년10월수치적10례인동골분우문육류환자적림상화수방자료,소유환자술전균채용신보조화료,행수술절제중건병보이술후화방료.화료채용이배린선알、아매소+순박방안.채용전통절제중건수술5례,채용계산궤보조진행종류정학절제5례,골분중건시괄당강저환측관관절선전중심.결과 신보조화료후,완전완해1례,부분완해8례,은정1례.수술후지체공능평분위우4례,량호4례,일반1례,차1례.사용도항계산궤기술보조치료적5례환자종류절제완정,내고정위치준학,미출현국부복발.전조환자균무엄중병발증적발생.평균수방37.8개월,10례환자전부생존,단유1례환자술후2년출현폐전이.전조유8례환자적골격생장발육미출현명현영향,유1례환자출현관관절선전중심실평형,유1례환자출현대상성척주측만.결론 이신보조화료、수술절제중건、술후화방료연합치료인동골분우문육류적료효교호;계산궤도항보조기술위인동골분종류적정학절제여중건제공료신적、유효적해결도경;인동관구Y형연골후판가능시우문육류국부침습적천연병장.
Objective To explore the effect of neo-adjuvant chemotherapy and computer-assisted surgery on children and adolescents with primary pelvic Ewing's sarcoma,and assess the therapeutic effect on the pelvic skeletal growth and development.Methods This is a retrospective analysis of 10 children with primary pelvic Ewing's sarcoma treated between Jan 2001 and Oct 2010 at the Department of Oncologic Orthopaedics at Xijing Hospital.There were 3 girls and 7 boys in the age of 7 to 16 years (average 12.7 years).All patients were pathologically diagnosed as Ewing's sarcoma.There were two cases in the sacroiliac joint,one in the ilium,one in the pubic bone,and 6 cases in peri-acetabular area including 5 below the triradiate cartilage and one above the triradiate cartilage,without cartilage invasion.All patients underwent neo-adjuvant chemotherapy,resection and reconstruction surgery and postoperative chemotherapy.CDP,ADM and IFO regimen chemotherapy were given as the main treatment.Five cases were treated by traditional resection and reconstruction,and after 2008,five cases were treated by computer-assisted surgery.During the reconstruction,the hip rotation center was put at a depressed location.All of the 10 cases underwent postoperative radiotherapy in a dose of 45-55 Gy.Results All patients were followed-up for 12-72 months (mean:37.8 months).One child had tumor recurrence and lung metastasis and 9 patients had no evidence of disease (NED).After neo-adjuvant chemotherapy,the oncologic statuses (RECIST)were:1 CR,8 PR and 1 SD.The functional recoveries after surgery (Enneking's) were:4 cases excellent,4 good,1 fair and 1 poor.Five cases who underwent computer-assisted surgery achieved a good reconstruction without local recurrence.There were no effects on skeletal growth in 8 cases.An unbalanced hip rotational center occurred in one case,and a compemsatory scoliosis was found in another case.There were no serious complications in all patients.Conclusions The comprehensive treatment including neoadjuvant chemotherapy,resection-reconstruction surgery and postoperative chemoradiotherapy may give a good control to primary pelvic Ewing's sarcomas in children and adolescents.The computer-assisted surgery used for accurate tumor resection and pelvic reconstruction is a good alternative when treating young patients with malignant pelvic tumors.The triradiate cartilage in children's acetabulum could be a natural barrier resistant to the invasion of Ewing's sarcomas.