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目的探讨在有效大剂量化疗前提下的保留骨骺灭活再植术的可行性。方法自1999年开始在MMIA方案(由甲氨喋呤、异环磷酰胺、阿霉素组成)的有效大剂量化疗保护下对2例儿童骨肉瘤患者行保留骨骺的灭活再植术。术前严格遵循新辅助化疗的原则,行2个疗程的MMIA化疗。化疗后患者疼痛消失,肿块缩小,AKP、LDH 明显下降,X线片及MR示左股骨下端病变局限,边缘清晰,硬化及骨化明显,骨骺未受侵蚀。术后继续应用2疗程化疗。结果2例患者术后切口均一期愈合。随访分别为3年和4年,无复发和转移,肢体功能恢复理想。结论保留骨骺的灭活再植术是治疗儿童骨肉瘤的一种新方法,其在不增加局部复发率的前提下避免术后双侧肢体不等长,并改善了术后患者的肢体功能。但严格掌握手术适应证是至关重要的,否则将导致灾难性后果。
Objective To explore the feasibility of preserving epiphyseal inactivation in the premise of effective large dose chemotherapy. Methods Two inpatients with osteosarcoma were enrolled in the inactivated epiphyseal replantation in MMIA regimen (methotrexate, ifosfamide and doxorubicin) under effective high dose chemotherapy protection since 1999. Strictly follow the principle of neoadjuvant chemotherapy before surgery line 2 MMIA chemotherapy. Chemotherapy patients with pain disappeared, the tumor shrinks, AKP, LDH decreased significantly, X-ray film and MR showed the left femur lesions limited edge clear, sclerosis and ossification, epiphyseal undaunted. After continuing to use 2 courses of chemotherapy. Results The incision healed in 2 cases. Follow-up was 3 years and 4 years, no recurrence and metastasis, limb function recovery ideal. Conclusion The preservation of epiphyseal replantation inactivation is a new method for the treatment of osteosarcoma in children. It can avoid the unequal length of bilateral limbs and improve the limb function of postoperative patients without increasing the local recurrence rate. However, it is crucial to have a rigorous surgical indication, otherwise catastrophic consequences will result.