骨盆区域复发骨与软组织肿瘤手术加术中放疗的围手术期安全性评价

张鹏; 蔡启卿; 刘海龙; 王家强; 李超; 牛晓颖; 巴云涛

doi:10.3971/j.issn.1000-8578.2017.01.011

骨盆区域复发骨与软组织肿瘤手术加术中放疗的围手术期安全性评价

Perioperative Security Evaluation of Intra-operative Radiotherapy for Recurrent Bone and Soft Tissue Sarcomas Around Pelvis

摘要

摘要:
目的探讨骨盆复发骨与软组织肿瘤手术联合术中放疗（intra-operative radiation therapy, IORT）的安全性。
方法随机选取在郑州大学附属肿瘤医院住院的骨盆复发骨与软组织肿瘤患者40例，将其分为两组：手术联合IORT组（n=20），行骨盆肿瘤手术联合IORT；术前放疗联合手术组（n=20），术前常规放疗后行肿瘤扩大切除手术。比较两组患者术中、术后指标及并发症发生情况等。
结果手术联合IORT组20例患者中发生术后直肠、膀胱并发症1例，明显少于术前放疗联合手术组（6例），差异有统计学意义（P < 0.05）；手术联合IORT组患者术中出血量为（946.33±66.27）ml，略多于术前放疗联合手术组患者（750.66±56.19）ml；但手术联合IORT组患者住院时间和切口拆线时间分别为（8.27±0.64）d和（13.53±0.65）d，明显短于对照组（10.67±1.15）d和（16.17±0.76）d，差异均具有统计学意义（P < 0.05）。手术时间、术后血液白细胞计数、术后创腔引流量、切口液化及口感染，两组比较，差异无统计学意义（P > 0.05）。
结论骨盆复发性骨与软组织肿瘤手术联合IORT具有术后易恢复、安全性好、常规放疗相关并发症少等优点，在临床应用中是安全可行的。

Abstract:
Objective To explore the perioperative security of intra-operative radiotherapy (IORT) for recurrent bone and soft tissue sarcomas around the pelvis.
Methods The patients with recurrent bone and soft tissue sarcomas around the pelvis that were treated in our hospital or outside by surgical operation were regarded as subjects. Fourty cases were screened finally and divided into preoperative radiotherapy combined with surgery resection group (n=20), named control group, and operation combined with IORT group (n=20, performed with extensive operation combined IORT). Some important intraoperative index, postoperative index, and complications of the two groups were compared after treatment.
Results There was 1 case with rectum and cystitis complication in operation combined with IORT group, but there were 6 cases in control group, the difference was statistically significant (P < 0.05); The blood loss of the patients in operation combined with IORT group was (946.33±66.27) ml, which was more than that in control group, (750.66±56.19) ml (P < 0.05). But the hospitalization time and suture removal time in operation combined with IORT group were (8.27±0.64) d and (13.53±0.65) d respectively that were significantly shorter than those in control group, (10.67±1.15) d and (16.17±0.76) d (P < 0.05). There was no significant difference on operation time, leucocyte count, wound cavity drainage, the case number of wound infection, or wound fat liquefaction between these two groups (P > 0.05).
Conclusion The evaluation of operation combined with IORT for recurrent bone and soft tissue sarcomas around the pelvis is good, safe and with fewer postoperative complications, but the long-term effect needs to be explored further.

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