四肢恶性骨肿瘤保肢手术失败的原因分析

Analysis of the failure of limb salvage surgery for malignant bone tumors in extremities

目的探讨四肢恶性骨肿瘤保肢手术存在的诊疗失误,分析保肢手术失败的原因。方法回顾性分析2005年4月至2010年6月新疆医科大学附属肿瘤医院收治的16例四肢恶性骨肿瘤患者保肢手术时存在的诊断和治疗缺陷。结果 16例患者保肢手术失败的原因包括:(1)对四肢恶性骨肿瘤疾病缺乏认识;(2)病理诊断困难;(3)对新辅助化疗及术后化疗认识不足;(4)对四肢恶性骨肿瘤保肢手术适应证把握不恰当;(5)肿瘤切除的手术边界不足;(6)肿瘤切除后重建方式选择不当;(7)活检通道选择错误。结论对四肢恶性骨肿瘤患者实施保肢手术应尽量避免上述诊疗缺陷,提高保肢手术的成功率。

Objective To summarize the misdiagnosis and the mistreatment during the limb salvage operations for the patient with limb malignant bone tumor, and then to analyze the reasons of failure of limb salvage surgery. Methods Sixteen patients with malignant bone tumor in extremities were treated by limb salvage surgery from April 2005 to June 2010 with wrong methods of diagnosis and treatment, the records were collected and retrospectively analyzed. Results Potential reasons were as follows in this group： 1. Failure to recognize malignant bone tumor in extremities; 2. Difficulty in pathological diagnosis; 3. Insufficiency to know about neoadjuvant chemotherapy and postoperative chemotherapy; 4. Inappropriate understanding of indication of limb salvage surgery; 5. Insufficient surgical border for tumor resection; 6. Improper methods of reconstruction after tumor resection; 7. Failure to obtain enough biopsy tunnel. Conclusion Given the above 7 potential reasons being considered, more successful limb-preserving surgery for limb malignant bone tumor may be able to achieved.