臂丛区域肿瘤外科分区建议及手术入路探讨  

Suggestions for surgical classification of and operative approach to brachial plexus region tumors

作　　者：沙漠[1] 丁真奇[1] 康两期[1] 洪海森[1] 王臻[2] 郭征[2] 

机构地区：[1]厦门大学附属东南医院解放军第175医院全军骨科中心,漳州363000 [2]第四军医大学附属西京医院全军骨科研究所,西安710032

出　　处：《中国骨与关节杂志》2017年第2期101-107,共7页Chinese Journal of Bone and Joint

摘　　要：目的探讨臂丛区域肿瘤外科分区方法及相应手术路径,评估手术疗效及预后。方法回顾2008年1月至2014年12月收治的19例臂丛区域肿瘤患者。根据肿瘤相对臂丛主干解剖空间位置进行外科分区:臂丛上方、臂丛下方、臂丛内部、臂丛前方、臂丛后方,并采取相应的手术入路:锁骨上方入路、经典臂丛前路、改良三角肌胸大肌间隙入路、锁骨截骨入路、后方肩胛下入路,分析其临床结果。结果所有患者均获8~49个月随访,平均24.1个月。良性肿瘤10例(52.63%),交界性肿瘤3例(15.79%),恶性肿瘤6例(31.58%)。边缘切除13例,囊内切除6例,切缘阳性3例。2例术中并发神经损伤,随访末期1例症状改善。10例术前疼痛患者,术后8例疼痛消失,2例缓解。1例术前感觉异常患者术后症状缓解。6例术前活动障碍患者,术后4例恢复正常,2例得到改善。良性肿瘤随访过程均无复发。交界性复发2例。恶性肿瘤1例术后8个月因肺转移死亡,其余均健在未复发转移。结论根据肿瘤相对臂丛主干解剖空间位置,将臂丛区域肿瘤进行外科分区并选择相应的手术入路,此方法简单易交流,可获得良好的手术效果。Objective To investigate the surgical classification of and the corresponding surgical approach to brachial plexus region tumors, and to evaluate the surgical outcomes and prognosis. Methods A retrospective study was performed from January 2008 to December 2014 after surgical treatment of brachial plexus region tumors in 19 cases in our department. According to the space relationship between tumour and brachial plexus, we proposed a relatively simple surgical partitioning method and gave advice for the corresponding operative approach： （ 1 ） Upper brachial plexus tumor （ anterior supraclavicular ）; （ 2 ） Interior brachial plexus tumor （ classic anterior clavicular ）; （ 3 ） Inferior brachial plexus tumor （ utilitarian shoulder approach ）; （ 4 ） Anterior brachial plexus tumor （ clavicle osteotomy ）;（ 5 ） Posterior brachial plexus tumor （ posterior subscapular ）. Postoperative analysis of pathological features, surgical complications and follow-up information was performed to understand the extent of improvement in symptoms, relapse and mortality of the 19 cases. Results The 19 patients were followed up for a range from 8 to 49 months （ average =24.1 months ）. There was no recurrence of benign tumor during follow-up. Two patients developed C8 and T1 nerve root symptoms in postoperative period, one patient with the C8 nerve root symptoms did not significantly improve during the follow-up for 29 months, the other patients with the T1 nerve root symptoms improved after 1 month. In patients who complained of pain at presentation, 8 became pain free, while pain severity was reduced after surgery in the remaining 2 patients. Only one patient with sensory loss at initial presentation, reported postoperative remission of the symptom. After surgery, motor deficits improved in 4 patients and resolved in 2 patients. One patient presented with new motor deficits postsurgery, who subjected to an en bloc resection, did not improve. Two patients diagnosed as desmoid had recurrence. One

关 键 词：臂丛 软组织肿瘤 外科手术 

分 类 号：R738[医药卫生—肿瘤]