2015 年第 4 期 第 13 卷

肿瘤源性骨软化症9例诊治分析

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关键词：肿瘤源性骨软化症磷酸盐尿性间叶肿瘤低磷血症骨软化症

• 摘要：
• 【摘要】目的 对9例肿瘤源性骨软化症（tumor-induced osteomalacia，TIO）的临床特点、诊断和治疗进行总结和分析，以提高临床医师对该病的认识。方法 收集9例TIO患者的临床资料，比较手术前后的血生化指标改变。结果 患者均有骨痛、无力及活动受限，实验室检查提示低磷血症，骨扫描示骨软化症表现。9例患者均行奥曲肽显像（99mTc-OCT），其中8例诊断部位正确，另1例定位不准确，后经Ga-68-TATE及其他影像学检查确诊病灶部位。8例病理诊断为磷酸盐尿性间叶组织肿瘤，1例为胸膜外脂肪瘤样型孤立性纤维性肿瘤。7例患者在明确肿瘤定位后即行手术切除，术后血磷恢复正常，并在术后6-12个月保持在正常水平。结论 TIO多见于成人起病、无家族史的低磷骨软化症患者。奥曲肽显像对本病的诊断具有重要意义，影像学检查对于协助病灶的诊断和定位有帮助。确定肿瘤病灶之后及时行手术切除，是目前最有效的治疗方法。
• Objective To improve clinical diagnosis and treatment of tumor-induced osteomalacia (TIO). Method We summarized and analyzed comprehensive clinical data (including clinical presentation, management, radiographic test, biochemical test, peri- and post-operative clinical status) of 9 cases with TIO. Result All the 9 patients presented with bone pain and muscle weakness, hypophosphatemia and phosphaturia. Results of radiographic test showed that all patients have osteoporosis and the features of metabolic bone diseases. 99mTc-OCT was performed in all 9 patients and 8 of 9 cases showed correct tumor focus, one patient obtained adjusted determination for tumor focus with the help of Ga-68-TATE, CT and MRI. The diagnosis of 8 patients was confirmed by histopathology (phosphaturic mesenchymal tumor) after operation or biopsy. Serum Pi level returned and retained to normal after resection of tumors for 7 patients. Conclusion TIO is mostly seen in adult osteomalacia cases with hypophosphatemia and without family medical history. 99mTc-OCT and other image examinations are very helpful to diagnose and locate the tumors. In addition, Ga-68-TATE is also a useful measurement in recent years. A complete resection of tumors is the most effective treatment for TIO.