肿瘤骨转移的表现和诊疗
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">骨转移是恶性肿瘤<span style="color: black;">平常</span>并发症之一，平均每5个<span style="color: black;">病人</span>中就会有1个<span style="color: black;">出现</span>骨转移，且多为多发性骨转移。肿瘤骨转移对<span style="color: black;">病人</span>威胁很大，不管在身体还是心理上都会产生很大的打击。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">骨肿瘤有<span style="color: black;">非常多</span>种，其中转移性骨肿瘤是最<span style="color: black;">平常</span>的一种，这种<span style="color: black;">疾患</span>发病奇怪，让<span style="color: black;">非常多</span><span style="color: black;">病人</span>感到痛苦不堪，<span style="color: black;">那样</span>转移性骨肿瘤的症状有什么呢？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">01</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">转移性骨肿瘤的症状</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">01 <span style="color: black;">病痛</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">最<span style="color: black;">平常</span>的症状，约占70%。<span style="color: black;">病痛</span>的<span style="color: black;">显现</span>时间可早可晚，<span style="color: black;">病痛</span>的性质<span style="color: black;">亦</span>可轻可重，病程<span style="color: black;">通常</span>较长。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病痛</span>的程度不一，在<span style="color: black;">初期</span>，<span style="color: black;">病痛</span>较轻，呈间歇性，<span style="color: black;">逐步</span>变为<span style="color: black;">连续</span>性，严重者易<span style="color: black;">导致</span><span style="color: black;">重视</span>，轻者常被<span style="color: black;">忽略</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">位置于</span>脊柱者可表现为腰部、胸背部、肋胸部、颈<span style="color: black;">病痛</span>。在胸椎者常伴单侧或双侧的肋间神经痛。在腰椎者有时<span style="color: black;">能够</span>表现出腹痛。<span style="color: black;">病痛</span>的特点是常有变化，制动多<span style="color: black;">没</span>效，<span style="color: black;">病痛</span>的程度越来越重，<span style="color: black;">发展</span><span style="color: black;">快速</span>。<span style="color: black;">位置于</span>骨盆者，常伴有髋关节、股内侧<span style="color: black;">病痛</span>;<span style="color: black;">位置于</span>股骨上端及肱骨上端者常伴<span style="color: black;">相关</span>节功能<span style="color: black;">阻碍</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">02 肿胀、包块</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">位置于</span>深部的骨转移肿瘤<span style="color: black;">初期</span>常<span style="color: black;">很难</span><span style="color: black;">发掘</span>包块，只反映出局部的<span style="color: black;">病痛</span>，表浅者部分病例可见肿胀及包块，约占5%，<span style="color: black;">因此</span>因包块而就诊者极少见。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">靠近关节<span style="color: black;">周边</span>的肿瘤<span style="color: black;">能够</span><span style="color: black;">导致</span>关节功能的<span style="color: black;">阻碍</span>，肿瘤增大在<span style="color: black;">要紧</span>的神经<span style="color: black;">周边</span>时<span style="color: black;">能够</span>有或多或少的压迫症状，产生麻木、肌肉<span style="color: black;">没</span>力或萎缩，不少病例的诊断是在病理骨折<span style="color: black;">出现</span>时才<span style="color: black;">发掘</span>了骨骼的病变，要<span style="color: black;">尤其</span><span style="color: black;">导致</span><span style="color: black;">注意</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">03 压迫症状</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">脊柱转移肿瘤常<span style="color: black;">火速</span><span style="color: black;">显现</span>脊髓、马尾或神经根的压迫症状，<span style="color: black;">显现</span>根性神经痛，感觉可<span style="color: black;">衰退</span>，肌力减弱以至麻痹，常伴括约肌功能<span style="color: black;">阻碍</span>。以麻痹为首症者约占2%，因瘫痪而入院者几乎占50%。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在骨盆者可<span style="color: black;">导致</span>直肠、膀胱的压迫症状，<span style="color: black;">显现</span><span style="color: black;">体积</span>便功能<span style="color: black;">阻碍</span>。<span style="color: black;">位置于</span>肢体者<span style="color: black;">也</span>可<span style="color: black;">导致</span>血管和神经干的压迫症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">04 病理性骨折</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">常为转移性骨肿瘤的<span style="color: black;">重点</span>症状之一，有轻微外伤或<span style="color: black;">基本</span><span style="color: black;">无</span>任何诱因，即<span style="color: black;">出现</span>了骨折。在下肢<span style="color: black;">显现</span>率最高，一旦发<span style="color: black;">患病</span>理性骨折，<span style="color: black;">病痛</span>加重，肿胀<span style="color: black;">显著</span>。在脊柱者<span style="color: black;">火速</span>即<span style="color: black;">显现</span>瘫痪。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">05 全身症状</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">有原发癌症状者，周身<span style="color: black;">状况</span>差，常有贫血、消瘦、低热、乏力、食欲<span style="color: black;">衰退</span>等。<span style="color: black;">没</span>原发癌表现者，病人全身<span style="color: black;">状况</span>常较好，部分病人如正<span style="color: black;">一般人</span><span style="color: black;">同样</span>，但<span style="color: black;">火速</span>即<span style="color: black;">显现</span>周身症状。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">02</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">怎样</span>判断骨转移？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">是不是真的<span style="color: black;">出现</span>肿瘤骨转移？<span style="color: black;">病痛</span>并不是<span style="color: black;">评估</span>诊断“金标准”。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">病友们<span style="color: black;">倘若</span><span style="color: black;">发掘</span><span style="color: black;">病痛</span>，要尽快到医院去做X线<span style="color: black;">检测</span>、CT<span style="color: black;">检测</span>、MRI<span style="color: black;">检测</span>及全身骨扫描；临床上，将PET/CT和CT<span style="color: black;">检测</span>二者进行组合<span style="color: black;">检测</span>，能够较早<span style="color: black;">发掘</span>转移病灶。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">对仅存在于骨髓腔内的<span style="color: black;">初期</span>转移灶MRI有很高的灵敏度，能准确<span style="color: black;">表示</span>侵犯部位、范围及<span style="color: black;">周边</span>软组织<span style="color: black;">状况</span>，并<span style="color: black;">能够</span>多平面<span style="color: black;">影像</span>，有助于探寻其他较易行穿刺活检部位的转移灶。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌转移<span style="color: black;">指的是</span>癌细胞扩散到距发病部位较远的其他器官。<span style="color: black;">身体</span>癌细胞常常会<span style="color: black;">经过</span>血液循环系统和淋巴系统转移到身体的其他部位。<span style="color: black;">平常</span>的转移部位<span style="color: black;">包含</span>骨骼、肺部和肝脏。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">03</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">那些</span>癌症易<span style="color: black;">出现</span>骨转移？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">科研</span><span style="color: black;">表示</span>，有五种类型的癌症较易<span style="color: black;">出现</span>骨转移，分别是乳腺癌、前列腺癌、肺癌、甲状腺癌和肾癌，占了骨转移肿瘤的90%以上。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">必须</span><span style="color: black;">重视</span>的是，并不是这些癌症都会发生骨转移。<span style="color: black;">例如</span>，乳腺癌会<span style="color: black;">出现</span>骨转移概率是67%~75%，而<span style="color: black;">针对</span>肺癌则是30%~40%的概率会<span style="color: black;">出现</span>骨转移，肾癌<span style="color: black;">病人</span>中20%~35%会<span style="color: black;">显现</span>骨转移；而消化道肿瘤，如胃癌、肝癌、肠癌等<span style="color: black;">出现</span>骨转移的几率并不高。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">04</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">骨转移不同的临床表现</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">骨转移<span style="color: black;">出现</span>在不同的部位<span style="color: black;">导致</span>不同的临床表现，以骨损害、<span style="color: black;">病痛</span>为<span style="color: black;">重点</span>表现。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肋骨转移<span style="color: black;">导致</span>的胸痛，多表现为胸壁部位局限的、有<span style="color: black;">知道</span>压痛点的<span style="color: black;">病痛</span>。脊髓转移<span style="color: black;">导致</span>后背部正中或病变部位<span style="color: black;">病痛</span>以及脊髓的压迫症状，而四肢或躯干的骨转移<span style="color: black;">导致</span>该部位的局限性<span style="color: black;">病痛</span>及放射性<span style="color: black;">病痛</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在肿瘤骨转移的<span style="color: black;">初期</span>，大<span style="color: black;">都数</span><span style="color: black;">病人</span><span style="color: black;">无</span><span style="color: black;">显著</span>的<span style="color: black;">病痛</span>症状，而表现为周身的乏力、不适等症状。一旦骨转移到了后期，<span style="color: black;">都数</span><span style="color: black;">病人</span>会<span style="color: black;">显现</span>较剧烈的骨痛。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌症<span style="color: black;">病人</span>被癌细胞侵袭的骨骼如同被虫蛀的“朽木”般脆弱，极易<span style="color: black;">出现</span>骨折。在跌倒、创伤等外力<span style="color: black;">功效</span>下，<span style="color: black;">乃至</span>弯腰<span style="color: black;">或</span>转身过猛都有可能<span style="color: black;">诱发</span>椎骨等骨折，就诊时才<span style="color: black;">发掘</span><span style="color: black;">已然</span>骨转移了。这将给<span style="color: black;">病人</span>的身心受到<span style="color: black;">损伤</span>，<span style="color: black;">亦</span>使<span style="color: black;">病人</span>的<span style="color: black;">存活</span>质量和<span style="color: black;">存活</span>期都会受到严重影响。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">鉴于此，<span style="color: black;">针对</span>癌症<span style="color: black;">病人</span>，<span style="color: black;">定时</span>随访观察<span style="color: black;">非常</span>必要。不论有<span style="color: black;">无</span>骨痛</p>
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