四肢恶性肿瘤的保留肢体手术治疗

ABSTRACTLIMB SALVAGE PROCEDURE FOR TREATING MALIGNANT TUMOR OF EXTREMI-TIES

１９７４年１１月～１９９３年１２月，对经病理证实的１１０例四肢恶性肿瘤，做保留肢体的手术治疗。其中４２例肿瘤局限于软组织内，采用肿瘤彻底切除后，带血管蒂或吻合血管的皮瓣或肌皮瓣修复。５１例肿瘤局限于骨组织内，手术切除后的骨缺损，采用自体长骨植骨，吻合血管的骨移植术，深低温保存的同种异体骨及人工假体置换术等多种形式来替代。骨愈合时间为２．５～３．５个月。对１７例病变累及骨及软组织的，施行短缩肢体的瘤段切除术。经２～９年随访共有５３例生存，生存率为４８．２％。讨论了保留肢体手术的适应证和禁忌证，各手术方法的优缺点及肿瘤切除时需注意的问题。

ince November 1974 to December 1993, 110 cases with malignant tumors of the extremi- ties were treated bv en bloc resectiOn and limb salvage procedure in our hopsital.There were 57males and 53 females.Their ages ranged from 14 to 70 years.The diagnosis of all patients wereconfirmed by pathology. Among them,68 cases were malignant bone tumor,42 cases were ma-lignant tumor of soft tissue. If the soft tissue was involved by the malignant tumors,the tumorwas resected radically and myocutaneous or sk in flap was transferred to covered the defect. A-mong the 42 cases, 5 were free vascularized and 37 were pediculated flaps. The maximal size ofthe flap was 15×25 cm and the minimal was 6×8cm,For the n1aiignant bone tumors, en blocresection was performed and the bone defect was reconstructed with autogenous free vascularizedfibular graft, autograft of massive bone with fusion or allograft of cryogenic massive bone. If thejoint was in volved,limited excision with replacement of prosthesis was recommended. Whenboth soft tissue and bone were involved, segmental resection of tumor was indicated in 17 cases. The patients were followed up for 2 to 9 years, the results of 53 cases were still alive with a sur-vival rate of 48.2%. We emphasized that the local extensive resection should be performed witha safety margin of 3 to 5 cm beyond the tumor. Adjuvant chemotheapy and radiotherapy haddefinite value in the treatment of some malignant tumors,so that preoperative or postoperativechemotherapy or radiotherapy was necessary. Sometimes radical resection of regional lymph rodeswas necessary, The indications and causes of recurrence were discussed.