软组织肉瘤非计划手术后的治疗与疗效分析  

Clinical treatment and analysis of soft tissue sarcoma after unplanned excision

作　　者：黄勇兄 李建民[2] 詹世强[1] 昌耘冰[1] 曾时兴[1] 马元琛[1] 梁昌祥[1] 郑秋坚[1] 杨强[2] 

机构地区：[1]广东省医学科学院,广东省人民医院骨科,广东广州510080 [2]山东大学齐鲁医院骨科,山东济南250012

出　　处：《中国肿瘤外科杂志》2015年第1期14-19,共6页Chinese Journal of Surgical Oncology

摘　　要：目的探讨软组织肉瘤患者非计划手术后的再手术切除及其治疗效果。方法回顾性分析44例已行非计划手术的软组织肉瘤患者行二次扩大切除术的复发、转移及生存情况等治疗效果。结果二次手术前无复发组共17例,2例在术后出现局部复发(11.8%),1例淋巴结转移并带瘤生存(5.9%),1例肺转移死亡。二次手术前已复发组共27例,13例在术后出现局部复发(48.1%),8例肺、肝或多发转移(29.6%),7例肺、肝或多发转移而死亡。两组的二次复发情况有显著性差异(P=0.021);转移情况无显著性差异(P=0.121)。患者在二次手术前是否复发及二次手术后是否复发对所有患者的总体生存情况影响无显著差异(P>0.05);两组患者总的5年无病生存率分别为86.3%±9.2%及40.3%±10.1%,有显著差异(P=0.003)。结论软组织肉瘤的局部复发对肿瘤的转移率及患者的总体生存率无明显影响,但会明显降低患者的无病生存率。软组织肉瘤一旦诊断明确应及时行二次扩大切除术治疗。Objective To explore the re-excision and its treatment of soft tissue sarcoma（ STS） patients who have performed unplanned excision. Methods All patients were divided into two groups according to the rate of recurrence before applying re-excision. Rate of recurrence,metastasis,and survival differed between the two groups. Statistical analysis was performed and SPSS Version 16. 0 was used for reference. Results There were 17 cases with no recurrence of soft tissue sarcoma before applying re-excision,and 27 cases with recurrence of soft tissue sarcoma before re-excision. The ratio of recurrence was 11. 8% and 48. 1% respectively,and P = 0. 021,with significant difference. While the ratio of metastasis was 5. 9%,and 29. 6% respectively,and P = 0. 121,with no significant difference. Kaplan-Meier univariate was used for overall survival in all cases of soft tissue sarcoma before and after re-excision. Respectively,there were no significant differences in both of the two groups. Cox proportional hazard model multivariate analysis was used for overall survival,and no significant difference. The 5-year disease-free survival was 86. 3% ± 9. 2% and 40. 3% ± 10. 1% respectively,witha significant difference（ P = 0. 003 0. 05）. Conclusions Re-excision can effectively reduce the rate of recurrence and improve disease-free survival. Local recurrence of soft tissue sarcoma did not have a measurable impact on metastasis and overall survival,but could significantly reduce the disease-free survival.

关 键 词：软组织肉瘤 非计划手术 复发 二次手术 

分 类 号：R738.6[医药卫生—肿瘤]