中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2011年
11期
978-981
,共4页
王晋%尹军强%沈靖南%唐清连%李浩淼%黄纲%邹昌业%赵志强
王晉%尹軍彊%瀋靖南%唐清連%李浩淼%黃綱%鄒昌業%趙誌彊
왕진%윤군강%침정남%당청련%리호묘%황강%추창업%조지강
肉瘤,软组织%放射疗法%预后
肉瘤,軟組織%放射療法%預後
육류,연조직%방사요법%예후
Sarcomas,soft tissue%Radiotherapy%Prognosis
目的 讨论广泛切除联合后装放疗在治疗毗邻血管神经主干肉瘤中的价值.方法 回顾性调查2000-2009年毗邻血管神经软组织肉瘤患者,入组条件:术前活检病理证实为软组织肉瘤,术前常规磁共振成像评估原发灶范围,显示肿瘤反应区涉及四肢主要血管神经,并且肿瘤反应区距离血管神经最近范围在1 cm以内;排除条件:磁共振成像显示肿瘤反应区未涉及四肢主要血管神经,并且肿瘤反应区距离血管神经最近范围在1 cm以上.入组86例软组织肉瘤患者,男41例,女45例;年龄15 ～73岁,平均38.5岁.肿瘤类型主要为恶性纤维组织细胞瘤、滑膜肉瘤、纤维肉瘤、脂肪肉瘤、腺泡状软组织肉瘤、横纹肌肉瘤、间叶性肉瘤、尤文肉瘤、平滑肌肉瘤、血管肉瘤、上皮样肉瘤和透明细胞肉瘤等.肿瘤PTNM分期:ⅠA期8例、ⅡA期12例、ⅡB期10例、ⅡC期7例、Ⅲ期43例、Ⅳ期6例.结果 入组患者平均随访53个月(24～102个月),远处转移发生率为32.56％ (28/86),淋巴转移率6.98％ (6/86).常规分离血管鞘内或神经外膜整体切除肿瘤,其中12例患者随访中发现复发,复发率为12/86( 13.95％),患肢MSTS功能评分平均为(24.37±2.4)分.在整块切除联合矩阵式多管后装放疗38例患者中,其中2例患者随访中发现复发,复发率为2/38(5.26％),术后4例患者出现伤口感染和6例伤口愈合不良;患肢MSTS功能评分平均为(21.11±1.79)分;在单纯整块切除48例患者中,其中10例患者随访中发现复发,复发率为10/48(20.83％).术后1例患者出现伤口感染和4例伤口愈合不良;患肢MSTS功能评分平均为(26.11±1.79)分,两者复发率比较差异有统计学意义(P＜0.05),两组术后功能评分比较没有统计学差异(t =5.184,P=0.285).结论 毗邻血管神经的软组织肉瘤,由于解剖结构的限制,广泛切除在小范围迫不得已改变为边缘切除,针对局部边缘切除后的矩阵式多管后装放疗,可以有效减少毗邻血管神经软组织肉瘤的局部复发.
目的 討論廣汎切除聯閤後裝放療在治療毗鄰血管神經主榦肉瘤中的價值.方法 迴顧性調查2000-2009年毗鄰血管神經軟組織肉瘤患者,入組條件:術前活檢病理證實為軟組織肉瘤,術前常規磁共振成像評估原髮竈範圍,顯示腫瘤反應區涉及四肢主要血管神經,併且腫瘤反應區距離血管神經最近範圍在1 cm以內;排除條件:磁共振成像顯示腫瘤反應區未涉及四肢主要血管神經,併且腫瘤反應區距離血管神經最近範圍在1 cm以上.入組86例軟組織肉瘤患者,男41例,女45例;年齡15 ～73歲,平均38.5歲.腫瘤類型主要為噁性纖維組織細胞瘤、滑膜肉瘤、纖維肉瘤、脂肪肉瘤、腺泡狀軟組織肉瘤、橫紋肌肉瘤、間葉性肉瘤、尤文肉瘤、平滑肌肉瘤、血管肉瘤、上皮樣肉瘤和透明細胞肉瘤等.腫瘤PTNM分期:ⅠA期8例、ⅡA期12例、ⅡB期10例、ⅡC期7例、Ⅲ期43例、Ⅳ期6例.結果 入組患者平均隨訪53箇月(24～102箇月),遠處轉移髮生率為32.56％ (28/86),淋巴轉移率6.98％ (6/86).常規分離血管鞘內或神經外膜整體切除腫瘤,其中12例患者隨訪中髮現複髮,複髮率為12/86( 13.95％),患肢MSTS功能評分平均為(24.37±2.4)分.在整塊切除聯閤矩陣式多管後裝放療38例患者中,其中2例患者隨訪中髮現複髮,複髮率為2/38(5.26％),術後4例患者齣現傷口感染和6例傷口愈閤不良;患肢MSTS功能評分平均為(21.11±1.79)分;在單純整塊切除48例患者中,其中10例患者隨訪中髮現複髮,複髮率為10/48(20.83％).術後1例患者齣現傷口感染和4例傷口愈閤不良;患肢MSTS功能評分平均為(26.11±1.79)分,兩者複髮率比較差異有統計學意義(P＜0.05),兩組術後功能評分比較沒有統計學差異(t =5.184,P=0.285).結論 毗鄰血管神經的軟組織肉瘤,由于解剖結構的限製,廣汎切除在小範圍迫不得已改變為邊緣切除,針對跼部邊緣切除後的矩陣式多管後裝放療,可以有效減少毗鄰血管神經軟組織肉瘤的跼部複髮.
목적 토론엄범절제연합후장방료재치료비린혈관신경주간육류중적개치.방법 회고성조사2000-2009년비린혈관신경연조직육류환자,입조조건:술전활검병리증실위연조직육류,술전상규자공진성상평고원발조범위,현시종류반응구섭급사지주요혈관신경,병차종류반응구거리혈관신경최근범위재1 cm이내;배제조건:자공진성상현시종류반응구미섭급사지주요혈관신경,병차종류반응구거리혈관신경최근범위재1 cm이상.입조86례연조직육류환자,남41례,녀45례;년령15 ～73세,평균38.5세.종류류형주요위악성섬유조직세포류、활막육류、섬유육류、지방육류、선포상연조직육류、횡문기육류、간협성육류、우문육류、평활기육류、혈관육류、상피양육류화투명세포육류등.종류PTNM분기:ⅠA기8례、ⅡA기12례、ⅡB기10례、ⅡC기7례、Ⅲ기43례、Ⅳ기6례.결과 입조환자평균수방53개월(24～102개월),원처전이발생솔위32.56％ (28/86),림파전이솔6.98％ (6/86).상규분리혈관초내혹신경외막정체절제종류,기중12례환자수방중발현복발,복발솔위12/86( 13.95％),환지MSTS공능평분평균위(24.37±2.4)분.재정괴절제연합구진식다관후장방료38례환자중,기중2례환자수방중발현복발,복발솔위2/38(5.26％),술후4례환자출현상구감염화6례상구유합불량;환지MSTS공능평분평균위(21.11±1.79)분;재단순정괴절제48례환자중,기중10례환자수방중발현복발,복발솔위10/48(20.83％).술후1례환자출현상구감염화4례상구유합불량;환지MSTS공능평분평균위(26.11±1.79)분,량자복발솔비교차이유통계학의의(P＜0.05),량조술후공능평분비교몰유통계학차이(t =5.184,P=0.285).결론 비린혈관신경적연조직육류,유우해부결구적한제,엄범절제재소범위박불득이개변위변연절제,침대국부변연절제후적구진식다관후장방료,가이유효감소비린혈관신경연조직육류적국부복발.
Objective With the extremity soft tissue sarcoma close to neurovascular bundle,combined en bloc resection and brachytherapy or simple en bloc resection were performed to evaluate the treatment outcome of the combined en bloc resection and brachytherapy.Methods Retrospectively investigation was performed for the extremity soft tissue sarcoma close to neurovascular bundle between 2000 and 2009.Inclusion criteria were primary extremity soft tissue sarcoma,MRI showed that the reaction zone involved the main neurovascular bundle,and the reaction zone closed less than 1 cm to the main neurovascular bundle.86 cases were included in the study.There were 41 men and 45 women.The average age was 38.5 years old (Range from 15 to 73 ).There were malignant fibrous histiocytoma,synovial sarcoma,fibrosarcoma,liposarcoma,clear cell sarcoma,epithelioid sarcoma,leiomyosarcoma,rhabdomyosarcoma and vascular sarcoma etc.The stage were IA (8),Ⅱ A ( 12),Ⅱ B ( 10),Ⅱ C (7),Ⅲ (43) and Ⅳ (6).Results During an average follow-up of 53 months ( range 24-102 months),the distant metastasis rate 32.56％ ( 28/86 ) and the lymph node metastasis rate was 6.98％ ( 6/86 ).The local recurrence rates was 13.95％ (12/86).In the group of combined en bloc resection and brachytherapy with 38 cases,the local recurrence rates was 5.26％ (2/38).Four cases had wound infection and six cases had wound delay healing.The MSTS functional score was 21.11 ± 1.79.In the group of simple en bloc resection with 48 cases,the local recurrence rates was 20.83％ (10/48).One case had wound infection and four cases had wound delay healing.The MSTS functional score was 84.23％ (26.11 ± 1.79).The local recurrence rates was significant different between.Conclusion With the extremity soft tissue sarcoma close to neurovascular bundle,combined en bloc resection and brachytherapy could decrease the local recurrence rate.
