氩氦刀冷冻序贯唑来膦酸治疗骨转移疼痛的疗效观察

doi:10.3760/cma.j.issn.1673-422X.2015.04.007

摘要/Abstract

摘要： 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。

关键词: 冷冻外科手术, 肿瘤转移, 疼痛, 双膦酸盐类

Abstract: ObjectiveTo investigate the clinical efficacy and safety of cryoablation combined with zoledronic acid sequential therapy for bone metastases pain.MethodsTwentyfour patients from our department 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.ResultsWithout serious complications, 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 statistical 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%.ConclusionCryoablation combined with zoledronic acid may be an effective therapeutic method with good safety in the treatment of patients with bone metastases pain.

Key words: Cryosurgery, Neoplasm metastases, Pain, Bisphosphonates

侯苏娟, 刘元水, 赵文华. 氩氦刀冷冻序贯唑来膦酸治疗骨转移疼痛的疗效观察[J]. 国际肿瘤学杂志, 2015, 42(4): 264-268.

HOU Su-Juan, LIU Yuan-Shui, ZHAO Wen-Hua. Efficacy of cryoablation combined with zoledronic acid sequential therapy for bone metastases pain[J]. Journal of International Oncology, 2015, 42(4): 264-268.

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