断层解剖学分析在四肢软组织肉瘤手术计划中的应用  

Role of sectional anatomy analysis in preoperative plan of soft tissue sarcoma of limbs

作　　者：李觅[1] 任晔[1] 杨卿[1] 郭风劲[1] 杨彩虹[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《骨科》2015年第6期290-294,共5页ORTHOPAEDICS

基　　金：武汉市科技计划基金(2014010202010091)

摘　　要：目的探讨断层解剖学分析在软组织肉瘤外科边界设计中的作用。方法 2012年3月至2014年12月我科收治四肢软组织肉瘤患者10例,术前行0.625 mm薄层扫描MRI和/或CTA检查。逐层详细分析断层解剖结构,确定肿瘤累及间室、反应带区域,以间室结合广泛边缘切除为原则准确设计肿瘤切除的边界,手术严格按照设计边界进行。对术后标本观察反应带和边界厚度,做两个维度最小边界测量,病理学检查明确肿瘤性质,确认切除标本边缘是否存在肿瘤细胞。结果 1术后肿瘤实体与术前断层解剖分析大小相比差异无统计学意义(P>0.05)。2术后测量肿瘤外正常组织厚度,手术类型达到广泛切除或治愈性切除标准,与术前计划一致。肿瘤完整切除,术后手术切缘病理检查未发现肿瘤细胞浸润。3末次随访患者功能恢复良好,未见肿瘤复发。结论逐层断层解剖分析为软组织肉瘤提供精确数字化外科边界,合理而精确切口设计,减少出血、创伤和肿瘤污染的可能性,有利于肿瘤切除时实现治愈性切除。规范断层解剖影像学检查和逐层断层解剖分析应该成为恶性软组织肉瘤切除术前设计必要步骤。Objective To investigate the role of sectional anatomy analysis in the preoperative plan of soft tissue sarcoma. Methods Retrospective analysis was taken with 10 soft tissue sarcoma patients who were hospitalized in our hospital from Mar. 2012 to Dec. 2014. Thin MRI scans and （or） CTA examinations were taken before the operations. Analyzing each single slice of image determined the anatomical informations such as compartment of tumor involved and reaction zones. According to the wide range and compartment principle, the surgical boundary of the tumors was designed. Measuring length of the reaction zone and minimal thickness of the boundaries in two dimensions on postoperative specimens. Pathological diagnosis was needed to confirm the presence of tumor cells on surgery margins. All the patients were followed up every three months. Results 1. There was no statistical significance between the size of postoperative tumor and preoperative sectional anatomy analysis on image（P）0. 05）. 2. According to the measurement of the normal tissue thickness in postoperative tumor, the type of sur- gery reached wide resection or curative resection standards. Pathological examination found no tumor cell infiltration on surgical margirL 3. All the patients had good functional recovery with no tumor recurrence at the last follow-up time. Conclusion Sectional anatomy analysis could provide precise surgical digital boundary and design reasonable incisions of soft tissue sarcoma, which would not only reduce the possi- bility of bleeding, trauma, tumor contamination but also achieve curative resection of tumor resection. Sectional anatomy analysis should become the necessary step in the preoperative plan of soft tissue sarcoma.

关 键 词：磁共振成像 诊断显像 软组织肿瘤 预测 

分 类 号：R739.96[医药卫生—肿瘤]