腹壁隆突性皮肤纤维肉瘤诊治策略及复发相关因素分析  

Derma to fibrosarcoma protuberans of the abdom in alwall: the diagnosis, treatment strategy and prognosis

作　　者：刘祥厦[1] 唐庆[1] 许澍洽[1] 黄洁新[2] 许扬滨[1] 

机构地区：[1]中山大学附属第一医院整形外科,广州510080 [2]广东省中医院影像科

出　　处：《中华普通外科学文献（电子版）》2014年第4期20-22,共3页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的 探讨腹壁隆突性纤维肉瘤的诊断与治疗方法,分析复发相关因素。方法 对51例腹壁隆突性皮肤纤维肉瘤患者的临床资料进行回顾性分析,根据是否放疗、切缘距离及肿瘤大小进行分组,比较组间术后复发率的差异。结果 患者肿物切除术后创面缺损面积4 cm×6cm至20cm×26cm,均I期予植皮、局部皮瓣或游离皮瓣修复,术后随访1-30.4年,总体复发率为23.1%,1例复发7次的患者发生肺转移。非放疗组与放疗组的复发率差异无统计学意义;切缘≤2cm组的复发率明显高于切缘〉2cm组（37.5%vs 19.4%,χ2=12.49,P〈0.01）;肿瘤≤5cm组患者复发率为16.7%,肿瘤〉5cm组患者的复发率为25.9%,两组间差异有显著统计学意义（χ2=3.91,P〈0.05）。结论 腹壁隆突性纤维肉瘤单纯局部切除复发率高,手术需行广泛切除,结合术后放疗并不能降低局部复发率。复发可能与肿瘤的大小、切缘距离等因素有关;多次复发可引起远处转移。Objective To investigate the diagnosis and treatment of dermatofibrosarcoma protuberans（DFSP） in abdominal wall and to analyze the correlative factors of recurrence. Methods Fifty- one cases of DFSP in abdominal wall were collected, the treatment and the correlative factors of recurrence subgrouping by the cutting edge and tumor size were analyzed retrospectively. Results The defect area was between 4 cm× 6 cm to 20 cm × 26 cm and patients received stage I repair. The total recurrent rate was 23.1% （9/39） with a regular follow up of 1-30.4 years, and there was one case with lung metastasis after 7 times of recurrence. The recurrence rate in non-radiotherapy group and radiotherapy group was 22.7% （5/22） and 23.5% （4/17） respectively, which showed no statistically significant difference. Comparing to 19.4% （6/31） in the group whose cutting edge was more than 2 cm from the tumor, the recurrence rate in the group less than 2 cm was 37.5%（3/8）. There was significant difference between these two groups （χ^2 =12.49, P 〈 0.01）. Less recurrence was observed in group with tumor size less than 5 cm（2/12）, comparing to the group with tumor size larger than 5 cm （7/27）（χ^2 =3.91, P 〈 0.05）. Conclusions DFSP in abdominal wall which tends to recur easily needs radically surgical intervention and repairs with skin-grafting or/and flaps. Radiotherapy after surgical resection may not contribute to better prognosis. Local recurrence is correlated to tumor size or/ and cutting edge. Repeated recurrence may cause distant metastasis.

关 键 词：隆突性纤维肉瘤 腹壁缺损 皮瓣 

分 类 号：R739.5[医药卫生—肿瘤]