CAJ | 학술논문

目的评价磁共振引导下聚焦超声术(MRgFUS)治疗疼痛性转移性骨肿瘤的安全性及有效性.方法 2014年6月至2015年2月对81例就诊于上海市第一人民医院的疼痛性转移性骨肿瘤患者进行筛选,对其中23例18周岁以上,有能力充分理解本研究知情同意书并表示意愿,疼痛数字量化评分(NRS) ≥4,过去2周靶病灶未接受放疗,以及过去2周未接受新开始的以针对缓解转移骨疼痛为目的化疗方案的患者进行了MRgFUS治疗.在治疗前、治疗后1周、1个月、3个月随访疼痛数字评价量表(NRS)、标准简明疼痛量表问题(BPI-QoL)、骨转移瘤患者生存质量调查问卷(EORTCQLQ-BM22)及相关不良事件发生情况.结果 (1)对全部23例患者的23个骨转移病灶进行了MRgFUS治疗,平均每例耗时(88±33) min,治疗每个病灶的聚焦超声脉冲数为(13±8)次.(2)治疗后出现的不良事件包括:治疗区域疼痛(3/23),1周内自行缓解;下肢麻木(1/23),理疗后缓解.(3)治疗前与治疗后1周、1个月和3个月的NRS分别为:(6.0±1.5)、(3.7±1.7)、(3.1±2.0)、(2.2±1.0)分,术后各时间点的疼痛评分均明显低于术前(均P＜ 0.01).(4)治疗前与治疗后1周、1个月和3个月的BPI-QoL评分分别为:(39±16)、(27±18)、(26±18)、(21±18)分,术后各时间点的评分均明显低于术前(均P＜0.01).(5)治疗前与治疗后1周、1个月和3个月的EORTC QLQ-BM22评分分别为:(52±13)、(44±12)、(42±12)、(39±12)分,术后各时间点的评分明显低于术前(均P＜0.01).结论 MRgFUS作为一种可用于治疗疼痛性转移性骨肿瘤的无创疗法,具有较高的安全性,且短期疗效确定,术后3个月可持续缓解疼痛和改善患者生活质量.
목적 평개자공진인도하취초초성술(MRgFUS)치료동통성전이성골종류적안전성급유효성.방법 2014년6월지2015년2월대81례취진우상해시제일인민의원적동통성전이성골종류환자진행사선,대기중23례18주세이상,유능력충분리해본연구지정동의서병표시의원,동통수자양화평분(NRS) ≥4,과거2주파병조미접수방료,이급과거2주미접수신개시적이침대완해전이골동통위목적화료방안적환자진행료MRgFUS치료.재치료전、치료후1주、1개월、3개월수방동통수자평개량표(NRS)、표준간명동통량표문제(BPI-QoL)、골전이류환자생존질량조사문권(EORTCQLQ-BM22)급상관불량사건발생정황.결과 (1)대전부23례환자적23개골전이병조진행료MRgFUS치료,평균매례모시(88±33) min,치료매개병조적취초초성맥충수위(13±8)차.(2)치료후출현적불량사건포괄:치료구역동통(3/23),1주내자행완해;하지마목(1/23),리료후완해.(3)치료전여치료후1주、1개월화3개월적NRS분별위:(6.0±1.5)、(3.7±1.7)、(3.1±2.0)、(2.2±1.0)분,술후각시간점적동통평분균명현저우술전(균P＜ 0.01).(4)치료전여치료후1주、1개월화3개월적BPI-QoL평분분별위:(39±16)、(27±18)、(26±18)、(21±18)분,술후각시간점적평분균명현저우술전(균P＜0.01).(5)치료전여치료후1주、1개월화3개월적EORTC QLQ-BM22평분분별위:(52±13)、(44±12)、(42±12)、(39±12)분,술후각시간점적평분명현저우술전(균P＜0.01).결론 MRgFUS작위일충가용우치료동통성전이성골종류적무창요법,구유교고적안전성,차단기료효학정,술후3개월가지속완해동통화개선환자생활질량.
Objective To evaluate the safety and efficacy of magnetic resonance guided focused ultrasound surgery (MRgFUS) in treatment for pain palliation of bone metastases.Methods Eighty-one patients of painful bone metastases were volunteered to screen for this study in Shanghai General Hospital from June 2014 to February 2015.Twenty-three patients among them were treated by MRgFUS,who was more than 18-years old,having the ability to fully understand the informed consent of the research,suffering with pain of numeric rating scale (NRS) ≥4,non-received radiotherapy or chemotherapy for pain palliation of bone metastases in the past two weeks.The NRS,the standard question of Brief Pain Inventory (BPI-QoL),and the standard question of Europe Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Bone Metastases22 (EORTC QLQ-BM22) were respectively recorded before and 1-week,1-month,3-month after the treatment.The related adverse events of MRgFUS were observed and recorded in 3 months after the treatment as well.Results (1) Twenty-three metastatic bone tumor lesions of 23 patients were treated by MRgFUS,the treatment data was as follows:the meantreatment time was (88 ± 33) minutes,the mean sonication number was 13 ± 8.(2) Adverse events included:pain in therapy area 3/23,which spontaneous relieving within one week;numbness in lower limb (1/23),which relieved after physiotherapy.(3) The NRS of before treatment and at 1-week,1-month,and 3-month after treatment respectively was 6.0 ± 1.5,3.7 ± 1.7,3.1 ± 2.0,and 2.2 ± 1.0,which significantly decreased after the treatment (P ＜0.01).(4) The BPI-QoL score of before treatment and at 1-week,1-month,and 3-month after treatment respectively was 39 ± 16,27 ± 18,26 ± 18,and 21 ± 18,which significantly decreased after the treatment (P ＜ 0.01).(5) The EORTC QLQ-BM22 score of before treatment and at 1-week,1-month,and 3-month after treatment respectively was 52 ± 13,44 ± 12,42 ± 12,and 39 ± 12,which also significantly decreased after the treatment (P ＜ 0.01).Conclusions MRgFUS can be used as a noninvasive,safe,and effective method for treating painful bone metastases.Its clinical benefits of pain palliation and patient's quality of life improving are sustained after the treatment at least to 3 months.