128例隆突性皮纤维肉瘤临床疗效分析

Clinical analysis of 128 patients with dermatofibrosarcoma protuberans

目的探讨隆突性皮纤维肉瘤的诊断、复发原因及早期扩大切除手术的治疗效果。方法1969～2001年我院共收治128例隆突性皮肤纤维肉瘤患者,对其临床和病理资料进行回顾性分析。结果128例隆突性皮肤纤维肉瘤行扩大切除54例,扩大切除加植皮或转移皮瓣修复术56例,局部切除术后行放疗10例。首诊误诊率高达52.2%。全组病例复发率为53.1%,8例死于肿瘤转移。首次手术即时或延期(术后3个月内)行扩大切除者60例,8例(13.3%)复发,明显低于总体复发率53.1%(χ2=28.4,P<0.001)。局部切除后行放射治疗10例,2年内4例(40%)复发,与总体复发率相比差异无显著性(χ2=0.642,P>0.05)。结论认识不足,首次治疗误诊,局部手术切除范围过于保守是局部复发率高的主要原因;早期三维扩大切除可有效降低隆突性皮肤纤维肉瘤的局部复发率;放射治疗不能降低局部复发率。

Objective To explore the diagnosis, reasons of recurrence and therapeutic effectiveness of early wide resection operation for dermatofibrosarcoma protuberans(DFSP).Methods The clinical and pathological data of 128 patients with DFSP treated at 81 Hospital of PLA from 1969 to 2001 were reviewed retrospectively.Results Out of 128 patients,54 underwent wide excision,56 underwent wide excision plus skin grafting or local flap grafting,10 received radiotherapy after local resection. The misdiagnosis rate at first diagnosis was high to ~52.2% .The overall local recurrence rate was 53.1% and 8 patients died of tumor metastasis.Sixty cases received wide resection in the first treatment or during 3 months and 8(13.3%) of them had recurrence of sarcoma,which was significantly lower compared with the overall recurrence rate(53.1%),χ2=28.4,P<0.001.Ten cases received radiotherapy after local resection the nidus and 4(40.0%) of them had recurrence of sarcoma during 2 years,which was not significantly different from the overall recurrence rate(53.1%),χ2=0.642,P>~0.05 .Conclusions The high local recurrence rate of DFSP is mainly attributed to inadeguate cognition ,high misdiagnosis rate and too small area resected in the first operation.Surgical operation is the optimal treatment, radical excision, especially 3-dimensional resection,is most important in the first or second treatment. Radiotherapy can not reduce the recurrence rate of DFSP in the patients only receiving local resection.