CAJ | 학술논문

目的：观察氩氦刀冷冻消融序贯唑来膦酸治疗骨转移性疼痛的临床疗效和安全性。方法对我科24例确诊为恶性肿瘤骨转移并伴中度以上疼痛的患者的28处病灶，在 CT 引导下行经皮穿刺氩氦刀冷冻消融治疗术，术后第3天给予唑来膦酸4 mg 加入0.9%氯化钠注射液100 ml 静脉滴注15 min 以上，后续每4周应用一次。数字评分法（NRS）及 Karnofsky 功能状态评分法（KPS）重复评价术前、术后第3天、序贯唑来膦酸治疗后第2周和第12周疼痛程度及生命质量。结果24例患者均成功准确地穿刺至骨转移病灶，无严重并发症发生。NRS 在术前、术后3 d、序贯唑来膦酸治疗后2周和12周分别为（7.70±0.86）分、（3.29±0.95）分、（2.54±0.83）分和（2.17±0.76）分，治疗前后差异有统计学意义（F =530.64，P <0.001），治疗后观察期内疼痛评价有效率91.67%。KPS 在术前、术后3 d、序贯唑来膦酸治疗后2周和12周分别为（45.83±6.54）分、（49.58±6.24）分、（61.67±7.01）分和（78.33±8.68）分，治疗前后差异有统计学意义（F =418.99，P <0.001），治疗后观察期内12周显效8例，有效10例，总有效率75.00%（18/24）。6个月后 CT 评价，局部完全缓解10例、部分缓解11例，有效率87.50%。结论氩氦刀冷冻消融序贯唑来膦酸治疗骨转移疼痛效果显著，具有良好的耐受性和安全性。
목적：관찰아양도냉동소융서관서래련산치료골전이성동통적림상료효화안전성。방법대아과24례학진위악성종류골전이병반중도이상동통적환자적28처병조，재 CT 인도하행경피천자아양도냉동소융치료술，술후제3천급여서래련산4 mg 가입0.9%록화납주사액100 ml 정맥적주15 min 이상，후속매4주응용일차。수자평분법（NRS）급 Karnofsky 공능상태평분법（KPS）중복평개술전、술후제3천、서관서래련산치료후제2주화제12주동통정도급생명질량。결과24례환자균성공준학지천자지골전이병조，무엄중병발증발생。NRS 재술전、술후3 d、서관서래련산치료후2주화12주분별위（7.70±0.86）분、（3.29±0.95）분、（2.54±0.83）분화（2.17±0.76）분，치료전후차이유통계학의의（F =530.64，P <0.001），치료후관찰기내동통평개유효솔91.67%。KPS 재술전、술후3 d、서관서래련산치료후2주화12주분별위（45.83±6.54）분、（49.58±6.24）분、（61.67±7.01）분화（78.33±8.68）분，치료전후차이유통계학의의（F =418.99，P <0.001），치료후관찰기내12주현효8례，유효10례，총유효솔75.00%（18/24）。6개월후 CT 평개，국부완전완해10례、부분완해11례，유효솔87.50%。결론아양도냉동소융서관서래련산치료골전이동통효과현저，구유량호적내수성화안전성。
Objective To investigate the clinical efficacy and safety of cryoablation combined with zoledronic acid sequential therapy for bone metastases pain. Methods Twenty-four patients from our depart-ment suffering from malignant tumors with moderate to severe pain due to bone metastases were enrolled in this study. Those patients with 28 metastatic bone tumors were successfully treated with cryoablation operations under CT-guided. Three days after cryoablation they were offered zoledronic acid(4 mg added in 100 ml normal saline,dripping for more than 15 min),once 4 weeks. Pain level and life quality were respectively evaluated by NRS(Numerical rating scale)and KPS(Karnofsky performance status),before cryoablation,3 days after cryoablation,2 weeks and 12 weeks after zoledronic acid sequential therapy. Results Without serious compli-cations,all of 24 patients were successfully punctured to tumor lesions. Patients’pain scores were 7. 70 ± 0. 86 (before cryoablation),3. 29 ± 0. 95(3 d after cryoablation),2. 54 ± 0. 83(2 weeks after zoledronic acid sequential therapy)and 2. 17 ± 0. 76(12 weeks after zoledronic acid sequential therapy),with a significant sta-tistical difference between pretherapy and post-treatment(F = 530. 64,P < 0. 001);during observation period after treatment,the effective rate in pain was 91. 67% . KPS scores were 45. 83 ± 6. 54(before cryoablation), 49. 58 ± 6. 24(3 d after cryoablation),61. 67 ± 7. 01(2 weeks after zoledronic acid sequential therapy)and 78. 33 ± 8. 68(12 weeks after zoledronic acid sequential therapy),with a significant statistical difference between pretherapy and post-treatment(F = 418. 99,P < 0. 001);during observation period after treatment, the effective rate in KPS was 75. 00% . Six months after the treatment,there were 10 cases of CR,11 cases of PR,and the effective rate was 87. 50% . Conclusion Cryoablation combined with zoledronic acid may be an effective therapeutic method with good safety in the treatment of patients with bone metastases pain.