治骨肿瘤，保命还能够保肢
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">骨癌的学名叫骨肿瘤，其发病隐匿，病情凶险，不仅会<span style="color: black;">引起</span>剧痛，还常常<span style="color: black;">导致</span>病人肢体残疾<span style="color: black;">乃至</span>危及生命。<span style="color: black;">因此呢</span>，骨癌似乎<span style="color: black;">成为了</span>“截肢”的代名词。然而，骨肿瘤如今早已由不治之症变<span style="color: black;">成为了</span>可治之症，<span style="color: black;">况且</span>大部分<span style="color: black;">病人</span>都<span style="color: black;">能够</span>保住肢体。</span></p><span style="color: black;">一</span><span style="color: black;">、骨肿瘤分为哪几类？最<span style="color: black;">平常</span>的是哪几种？</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">骨肿瘤<span style="color: black;">通常</span>分为原发性骨肿瘤和转移性骨肿瘤。前者的比例较小，在我国的发病率约为2~3/10万人口，约占<span style="color: black;">所有</span>恶性肿瘤的0.5%~1%。原发性骨肿瘤有上百种之多，其中以骨肉瘤最多，约占35%，其次为软骨肉瘤(25%)和尤文肉瘤(16%)。转移性骨肿瘤的发病率是原发性的30~40倍，临床诊断的骨肿瘤里，十有八九是转移瘤。如今恶性肿瘤的发病趋势整体<span style="color: black;">上升</span>，转移性骨肿瘤<span style="color: black;">亦</span>随之<span style="color: black;">增加</span>，但总体<span style="color: black;">来讲</span>，它们在<span style="color: black;">全部</span>肿瘤家族里属于少见肿瘤。</span></p><span style="color: black;">二</span><span style="color: black;">、骨肿瘤有<span style="color: black;">无</span>良恶之分？骨肿瘤的发病<span style="color: black;">原由</span>有<span style="color: black;">那些</span>？</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">骨肿瘤有良恶之分，<span style="color: black;">况且</span>良性多于恶性。良性骨肿瘤<span style="color: black;">包含</span>骨瘤、骨巨细胞瘤、骨样骨瘤、骨软骨瘤、骨囊肿等。其中，骨样骨瘤、骨软骨瘤等好发于青少年下肢骨干，生长非常缓慢，<span style="color: black;">能够</span>“不痛不痒”，有时<span style="color: black;">显现</span>压迫性<span style="color: black;">病痛</span>，<span style="color: black;">通常</span><span style="color: black;">没</span>需手术治疗。骨巨细胞瘤占原发性骨肿瘤的4%~5%，有潜在恶性倾向，有时<span style="color: black;">必须</span>手术治疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">原发性骨肿瘤的发病<span style="color: black;">原由</span>还不清楚，遗传是最<span style="color: black;">要紧</span>的危险<span style="color: black;">原因</span>，与现代生活方式的关系不大。青少年时期正<span style="color: black;">处在</span>快速生长<span style="color: black;">生长</span>的<span style="color: black;">周期</span>，最容易受到刺激和干扰。人的生长<span style="color: black;">生长</span>过程<span style="color: black;">便是</span>旧的细胞<span style="color: black;">持续</span>死亡，新的细胞<span style="color: black;">持续</span>产生，<span style="color: black;">倘若</span>在新的细胞产生过程中受到外界的刺激<span style="color: black;">或</span>环境的干扰，就会在生长<span style="color: black;">生长</span>过程中<span style="color: black;">出现</span>突变、变异。转移性骨肿瘤常由肺、肝脏、前列腺、乳腺、甲状腺等处的肿瘤<span style="color: black;">经过</span>血液循环转移而来，以乳腺癌、肺癌、前列腺癌最多。骨骼是除了肺和肝脏外癌细胞最“<span style="color: black;">爱好</span>”转移的部位。</span></p><span style="color: black;">三</span><span style="color: black;">、骨肿瘤在<span style="color: black;">那些</span>年龄段高发？</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">骨肿瘤好发年龄和生长部位各有不同，<span style="color: black;">例如</span>骨肉瘤好发于青少年，长骨干骺端多见(靠近膝关节、肘关节等处)；软骨肉瘤好发于四五十岁的中年人群，长骨末端和骨盆多见；尤文肉瘤好发于儿童、青少年，骨盆和脊椎等部位<span style="color: black;">平常</span>。转移性骨肿瘤多发于五六十岁的中老年人，最<span style="color: black;">重点</span>影响的是脊柱，其次是四肢。</span></p><span style="color: black;">四</span><span style="color: black;">、骨肿瘤有<span style="color: black;">那些</span>典型的<span style="color: black;">疾患</span>信号？</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">骨关节<span style="color: black;">病痛</span>、骨性肿块、功能<span style="color: black;">阻碍</span>是骨肿瘤后期的三大<span style="color: black;">重点</span>症状，但<span style="color: black;">初期</span><span style="color: black;">通常</span><span style="color: black;">无</span><span style="color: black;">显著</span>的症状，<span style="color: black;">病人</span>常在换衣服、洗澡时<span style="color: black;">忽然</span>摸到膝关节、肩关节等处长出一个“包”，此时肿瘤<span style="color: black;">已然</span>突破骨膜了，<span style="color: black;">通常</span>都到了2期，<span style="color: black;">发展</span><span style="color: black;">快速</span>。原发性骨肿瘤多<span style="color: black;">出现</span>于骨骼生长旺盛的青少年，<span style="color: black;">生长</span>期<span style="color: black;">常常</span>伴有生长痛，<span style="color: black;">孩儿</span>和家长都容易<span style="color: black;">忽略</span>。骨盆肿瘤<span style="color: black;">亦</span>难以<span style="color: black;">发掘</span>，<span style="color: black;">常常</span>是长得很大了，压迫神经<span style="color: black;">引起</span>剧烈<span style="color: black;">病痛</span>或压迫膀胱、直肠<span style="color: black;">显现</span><span style="color: black;">体积</span>便困难后，才来就诊。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">转移性骨肿瘤常表现出病理性骨折，还会因压迫神经而<span style="color: black;">引起</span>剧烈的癌性<span style="color: black;">病痛</span>、因脊髓压迫而<span style="color: black;">引起</span>瘫痪。<span style="color: black;">另外</span>，癌细胞转移到肢体骨骼，常以局部肿块为首发症状，转移到躯干时则以<span style="color: black;">病痛</span>为首发症状。</span></p><span style="color: black;">五</span><span style="color: black;">、骨肿瘤<span style="color: black;">此刻</span>能治愈吗？<span style="color: black;">是不是</span><span style="color: black;">必须</span>截肢？</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">30年前，骨肿瘤<span style="color: black;">病人</span>基本都是要截肢的。更令人<span style="color: black;">懊丧</span>的是，即使截肢<span style="color: black;">病人</span>的五年<span style="color: black;">存活</span>率<span style="color: black;">亦</span>不足20%，八成<span style="color: black;">病人</span>还是会<span style="color: black;">由于</span>癌细胞转移到肺、肝脏等处而死亡。而骨肉瘤这类发病凶险的肿瘤，患上了基本就等于“判了死刑”，高达九成<span style="color: black;">病人</span><span style="color: black;">最后</span>会死去。这是<span style="color: black;">由于</span>，骨肿瘤对化疗<span style="color: black;">药品</span>不太<span style="color: black;">敏锐</span>，<span style="color: black;">例如</span>常用的甲氨蝶呤在血液科是<span style="color: black;">根据</span>毫克计算的，而在骨科<span style="color: black;">通常</span>都是用克来计算，剂量大了副<span style="color: black;">功效</span><span style="color: black;">危害</span>就很大。放疗对大部分骨肿瘤<span style="color: black;">亦</span><span style="color: black;">没</span>效，只对尤文肉瘤和<span style="color: black;">少许</span>转移性骨肿瘤有<span style="color: black;">必定</span>效果。放疗对软骨和皮肤烧灼很厉害，皮肤会变硬，手术后切口老长<span style="color: black;">欠好</span>，<span style="color: black;">引起</span>感染率<span style="color: black;">上升</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">近年来，骨肿瘤的治疗有了<span style="color: black;">基本</span>性转变，尤其是“新辅助化疗”使保肢治疗<span style="color: black;">作为</span>可能。<span style="color: black;">详细</span>做法是术前先进行一个半月的大剂量化疗，使肿瘤缩小，术中<span style="color: black;">流血</span>减少，术后再追加半年化疗。如今，骨肿瘤治疗的五年<span style="color: black;">存活</span>率能达到60%~70%。<span style="color: black;">必须</span>解释的是，五年<span style="color: black;">存活</span>率并不等于<span style="color: black;">病人</span>术后只能活5年，而是说5年不复发。总而言之，骨肿瘤的治疗<span style="color: black;">存活</span>率比肺癌和肝癌还高。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">存活</span>率<span style="color: black;">加强</span>了，<span style="color: black;">病人</span>更<span style="color: black;">期盼</span>保肢。保肢<span style="color: black;">首要</span>要把肿瘤切干净。形象地说，骨肿瘤就像鸡蛋里面的蛋黄，<span style="color: black;">咱们</span>要把鸡蛋切开，把蛋黄取出来，但又<span style="color: black;">不可</span>让蛋黄(残存癌细胞)有一丝一毫的残留，<span style="color: black;">因此</span>取出来时得有一层薄薄的蛋清包着它。在临床上，只取“蛋黄”叫做边缘性切除，连“蛋清”<span style="color: black;">一起</span>取出叫做广泛性切除。<span style="color: black;">想要</span>保肢，<span style="color: black;">必定</span>要<span style="color: black;">尽可能</span>做到广泛性切除，<span style="color: black;">才可</span>将局部复发率<span style="color: black;">掌控</span>在规定的水平。</span></p><span style="color: black;">六 、骨肿瘤<span style="color: black;">怎样</span>早<span style="color: black;">发掘</span>？<span style="color: black;">那些</span>高危人群<span style="color: black;">必须</span>额外留意？</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">有肿瘤家族史的人<span style="color: black;">显现</span>骨关节<span style="color: black;">病痛</span>时，要<span style="color: black;">加强</span><span style="color: black;">警觉</span>。<span style="color: black;">例如</span><span style="color: black;">非常多</span>人都有过腰痛的经历，腰椎间盘<span style="color: black;">明显</span>、软组织<span style="color: black;">损害</span>、炎症等都可能<span style="color: black;">诱发</span>。但骨肿瘤的<span style="color: black;">病痛</span>是最剧烈的，特点是<span style="color: black;">病痛</span>夜间加重，<span style="color: black;">况且</span>越安静越痛，活动开了<span style="color: black;">病痛</span>反而减轻。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">再<span style="color: black;">例如</span>青少年膝关节痛，<span style="color: black;">孩儿</span>和家长可能认为是玩得太累了、运动受伤或长个子<span style="color: black;">导致</span>的生长痛，但生长痛一般是阵发性，骨肿瘤的<span style="color: black;">病痛</span>会<span style="color: black;">连续</span>加重，一两周都不缓解，还可能伴有低烧，此时<span style="color: black;">必定</span>要去医院拍个片子。</span></p><span style="color: black;"><span style="color: black;"><strong style="color: blue;">汤小东</strong></span></span>
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