软组织肉瘤补充广泛切除术的疗效分析

Secondary radical excision of soft tissue sarcoma

目的探讨补充广泛切除术在软组织肉瘤外科治疗中的意义。方法回顾性分析1998年1月至2005年10月收治的外院误诊为良性肿瘤而行局部切除的软组织肉瘤患者58例,均行补充广泛切除手术治疗。结果术后病理标本切除缘评价5cm者14例;3cm者32例;3cm以下者12例。首次术后肿瘤残存26例,占45%。补充广泛切除术后有28例需要行软组织修复重建。补充广泛切除手术后随诊10～94个月,8例复发,12例转移,死亡9例。均为高度恶性软组织肉瘤。Kaplan-Meier法计算5年生存率为84.5%,局部复发率为14%。切除缘的5年生存率3cm以上组和3cm以下组之间无显著性差异。局部复发率3cm以上组和3cm以下组有显著性差异(P<0.05)。结论补充广泛切除术是误诊软组织肉瘤最主要的治疗手段,补充广泛切除的标准切除缘的制定是今后的研究课题。缩小切除缘,可以改善预后,减少组织缺损所造成的修复重建。

Objective To investigate the curative effect of secondary radical excision after inadequate treatment of soft tissue sarcoma. Methods 58 patients with soft tissue sarcoma were retrospectively analyzed. All these patients were diagnosed as benign lesions before primary surgery and proved malignant postoperatively. Results There were 26 cases with tumor remaining after the first operation （45%）. After secondary radical excision, the recurrence was in 8 and metastasis in 12 and death in 9 at the duration of 10 to 94 months. 5-year- survival rate were 84.5% and the recurrence rate were 14%. Conclusions Secondary radical excision is the major important factor for the treatment of prior under-treatment soft tissue sarcoma. Reducing the range of excision can improve the prognosis and lessen the rate of reconstruct.