肢体软组织肉瘤709例外科治疗分析  

Surgical Treatment Analysis for 709 Patients with Soft Tissue Sarcoma

作　　者：曲兴龙[1] 柴宇啸[1] 韩毓[1] 张怡[1] 王炳[1] 王春萌[2] 陈勇[2] 

机构地区：[1]复旦大学附属肿瘤医院闵行分院肿瘤外科,上海200240 [2]复旦大学附属肿瘤医院胃及软组织外科,上海200032

出　　处：《肿瘤基础与临床》2015年第2期134-137,共4页journal of basic and clinical oncology

基　　金：上海市闵行区卫生局科研课题资助项目(编号:2010MW16)

摘　　要：目的探讨肢体软组织肉瘤（STS）的诊断与规范化的手术方式,以提高治疗效果。方法回顾性分析行手术治疗并经病理证实的709例肢体STS患者的临床资料。结果全组709例肢体STS患者中,术前行B超709例,CT 135例,MRI 587例。本组除216例行补充广泛切除术患者术前未再行术前活检,其余493例均进行术前活检,其中细针穿刺活检350例,粗针穿刺活检89例,切检54例。手术方式：434例行广泛切除术,125例行根治性间室切除术,113例行屏障切除术,37例行截肢术。术后病理检查结果显示,恶性纤维组织细胞瘤103例,滑膜肉瘤89例,脂肪肉瘤78例,横纹肌肉瘤74例,隆突性皮肤纤维肉瘤67例,纤维肉瘤62例,平滑肌肉瘤46例,腺泡状软组织肉瘤41例,透明细胞肉瘤36例,韧带样瘤型纤维瘤病31例,上皮样肉瘤29例,恶性神经鞘瘤27例,骨外尤文肉瘤11例,骨外骨肉瘤10例,血管肉瘤5例。531例术后随访0.3-4.5 a,73例复发（13.7%）,复发时间11-32个月,中位复发时间为21个月。127例（23.9%）出现远处转移,其中86例为肺转移,31例为肝转移,10例为骨转移。结论 MRI或CT应为术前常规的辅助检查,活检有助于明确诊断,手术是肢体STS最重要的治疗手段,规范化的手术方式可以降低复发率。Objective To explore the diagnosis and standardized operation mode of extremity soft tissue sarcomas （ STS）in order to improve the treatment efficacy. Methods The clinical data of 709 patients with extremity STS underwent surgical treatment were analyzed retrospectively. Results Of all the 709 patients,709 patients were examined with B ultrasound,and 135 patients with CT,587 patients with MRI. The 216 patients with supplementary wide resection received no preoperative biopsy,the remaining 493 patients received the preoperative biopsy（350 patients fine needle biopsy,89 patients coarse needle biopsy,54 patients cutting biopsy）. The operation mode：434 patients underwent wide local excision,125 patients radical resection,113 patients compartment barrier resection,37 patients amputation. The pathological diagnosis result after operation：103 patients with malignant fibrous histiocytoma,89 patients with synovial sarcoma,78 patients with liposarcoma,74 patients with rhabdomyosarcoma,67 patients with dermatofibrosarcoma protuberan,62 patients with fibrosarcoma,46 patients with leiomyosarcoma,41 patients with alveolar soft part sarcoma,36 patients with clear cell sarcoma,31 patients with desmoid type fibromatosis,29 patients with epithelioid sarcoma,27 patients with malignant schwannoma,11 patients with extraskeletal Ewing sarcoma,10 patients with extraskeletal osteosarcoma,and 5 patients with angiosarcoma. The 531 patients had been followed up for 0. 3 -4. 5 years,73 patients（13. 7%）had the local recurrence,the recurrence time was 11 -32 months and the median recurrence time was 21 months;127 patients（23. 9%）appeared the distant metastases（86 patients with lung metastasis,31 patients with liver metastasis,10 patients with bone metastases）. Conclusion MRI or CT should be taken as the routine preoperative examination,biopsy is helpful to the diagnosis of STS,operation is the most important method in the treatment of STS,the standardized operation mode can decrease the recurrence rate.

关 键 词：肢体 软组织肉瘤 手术 

分 类 号：R738.6[医药卫生—肿瘤] R730.56[医药卫生—临床医学]